Provider Demographics
NPI:1174610596
Name:KOVARIK, F DUANE (OD)
Entity type:Individual
Prefix:DR
First Name:F
Middle Name:DUANE
Last Name:KOVARIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 VALLEY VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1651
Mailing Address - Country:US
Mailing Address - Phone:308-728-5778
Mailing Address - Fax:
Practice Address - Street 1:3404 W. 13TH ST.
Practice Address - Street 2:STE 105
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2392
Practice Address - Country:US
Practice Address - Phone:308-382-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47060515300Medicaid
NE094338Medicare ID - Type Unspecified
NET40287Medicare UPIN