MEDICARE: DR. F DUANE KOVARIK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	840	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174610596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. F DUANE KOVARIK O.D.

Provider Business Mailing Address
First Line	:	402 VALLEY VIEW DR.
Second Line	:
City	:	ORD
State	:	NE
Zip	:	68862-1651
Country	:	US
Telephone Number	:	308-728-5778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 W. 13TH ST.
Second Line	:	STE 105
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-2392
Country	:	US
Telephone Number	:	308-382-6928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/27/2008

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