Provider Demographics
NPI:1700806999
Name:TUCKER, KIMBERLY J (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:TUCKER
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 1:5701 BOBOLI LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3407
Mailing Address - Country:US
Mailing Address - Phone:402-423-3937
Mailing Address - Fax:531-350-5774
Practice Address - Street 1:5701 BOBOLI LN STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3407
Practice Address - Country:US
Practice Address - Phone:402-423-3937
Practice Address - Fax:531-350-5774
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1155152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36328OtherBCBS
NE36328OtherBCBS
NE273140Medicare ID - Type Unspecified