Provider Demographics
NPI:1790073120
Name:NIEMANN, KATHY ANN (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 S 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1559
Mailing Address - Country:US
Mailing Address - Phone:402-955-2020
Mailing Address - Fax:402-955-2025
Practice Address - Street 1:1104 S 76TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1559
Practice Address - Country:US
Practice Address - Phone:402-955-2020
Practice Address - Fax:402-955-2025
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100-25-2246-00Medicaid