Provider Demographics
NPI:1053331652
Name:STELTING, GORDON C (OD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:C
Last Name:STELTING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-420-2020
Mailing Address - Fax:402-323-2002
Practice Address - Street 1:2005 E COURT ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310
Practice Address - Country:US
Practice Address - Phone:402-420-2020
Practice Address - Fax:402-223-5286
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06769OtherBCBS
NE22-00082OtherUHC
NET71363Medicare UPIN
NE097213Medicare ID - Type Unspecified