NPI 1083307979

Jacob Ethen, OD

Practitioner Optometrist Papillion, NE

Practice location

Address: 718 N Washington St, Papillion, NE 68046-3910
Phone: (402) 339-5717

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 1620 (NE)

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Registry record

NPI: 1083307979
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 May 2023
Record last updated: 13 Jul 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.