Provider Demographics
NPI:1750385464
Name:CULBERTSON, KAREN A (OD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:CULBERTSON
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 1:2510 S 171ST CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2394
Mailing Address - Country:US
Mailing Address - Phone:402-330-3063
Mailing Address - Fax:402-334-4418
Practice Address - Street 1:2510 S 171ST CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2394
Practice Address - Country:US
Practice Address - Phone:402-330-3063
Practice Address - Fax:402-334-4418
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06997OtherBLUE CROSS BLUE SHIELD
NE21460OtherSPECTERA
NE2200087OtherUNITED HEALTHCARE
NE470763296OtherTAX IDENTIFICATION NUMBER
NE2200087OtherUNITED HEALTHCARE
NE21460OtherSPECTERA
NE06997OtherBLUE CROSS BLUE SHIELD