Individual
JACOB ETHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
718 N WASHINGTON ST, PAPILLION, NE 68046-3910
(402) 339-5717
Mailing address
718 N WASHINGTON ST, PAPILLION, NE 68046-3910
(402) 339-5717
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1620
NE
Other
Enumeration date
05/29/2023
Last updated
07/13/2023
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