Active NPI
Jacob Ethen, OD
- Optometrist
- Papillion, NE
National Provider Identifier
1083307979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1620
- Practice address
- 718 N Washington St
Papillion, NE 68046-3910 - Phone
- (402) 339-5717
- NPI assigned
- May 29, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1620 | NE | Primary |
Addresses
Primary practice location
718 N Washington St
Papillion, NE 68046-3910
Mailing address
718 N Washington St
Papillion, NE 68046-3910
Phone (402) 339-5717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1620 | NE | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689206400000",
"number": "1083307979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "718 N WASHINGTON ST",
"city": "PAPILLION",
"state": "NE",
"postal_code": "680463910",
"telephone_number": "402-339-5717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "718 N WASHINGTON ST",
"city": "PAPILLION",
"state": "NE",
"postal_code": "680463910",
"telephone_number": "402-339-5717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHEN",
"first_name": "JACOB",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-29",
"last_updated": "2023-07-13",
"certification_date": "2023-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NE",
"license": "1620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Papillion, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.