Provider Demographics
NPI:1477635175
Name:KUBICA, MARSHA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:ANN
Last Name:KUBICA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14607 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3219
Mailing Address - Country:US
Mailing Address - Phone:402-330-3000
Mailing Address - Fax:402-330-2166
Practice Address - Street 1:14607 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3219
Practice Address - Country:US
Practice Address - Phone:402-330-3000
Practice Address - Fax:402-330-3000
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 1024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080843713Medicaid
NE272044KUMedicare PIN
NE47080843713Medicaid