Provider Demographics
NPI:1225173917
Name:STEINBERG, DEBORAH ELLEN (OD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN
Last Name:STEINBERG
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 1:1112 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1544
Mailing Address - Country:US
Mailing Address - Phone:209-575-2020
Mailing Address - Fax:209-758-5693
Practice Address - Street 1:1011 SYLVAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1692
Practice Address - Country:US
Practice Address - Phone:209-575-2020
Practice Address - Fax:209-758-5693
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9099T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225173917Medicaid
CA1225173917Medicaid
CAMS1136729OtherDEA
CA1225173917Medicaid
CASD0090991Medicare PIN
CABJ026ZMedicare PIN
CABJ026VMedicare PIN
CABJ026UMedicare PIN
CABJ026YMedicare PIN