Provider Demographics
NPI:1366888091
Name:KUEBER, JAMIE MAE (OD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MAE
Last Name:KUEBER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MAE
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-0549
Mailing Address - Country:US
Mailing Address - Phone:218-616-2780
Mailing Address - Fax:218-732-6957
Practice Address - Street 1:1011 1ST ST E
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1764
Practice Address - Country:US
Practice Address - Phone:218-732-8535
Practice Address - Fax:218-732-8535
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist