Provider Demographics
NPI:1942331145
Name:OMAHA PRIMARY EYE CARE, P.C.
Entity Type:Organization
Organization Name:OMAHA PRIMARY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUBICA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-330-3000
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:402-330-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1024152W00000X
NE1022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098883Medicare PIN
NE0401470001Medicare NSC