Organization
STATTON OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN A STATTON ABOC (OPTICIAN)
(402) 486-4828
Entity
Organization
Contact information
Practice address
4645 NORMAL BLVD STE 132, LINCOLN, NE 68506-5823
(402) 486-4828
Mailing address
4645 NORMAL BLVD STE 132, LINCOLN, NE 68506-5823
(402) 486-4828
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
ABOC 081991
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026128600
—
NE
01
—
6549480001
MEDICARE PTAN
NE
Enumeration date
05/31/2016
Last updated
05/31/2016
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