Provider Demographics
NPI:1316460827
Name:PETSKA, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PETSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7914
Mailing Address - Country:US
Mailing Address - Phone:402-332-0220
Mailing Address - Fax:402-332-0440
Practice Address - Street 1:814 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7914
Practice Address - Country:US
Practice Address - Phone:402-332-0220
Practice Address - Fax:402-332-0440
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2063152W00000X
NE1486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist