Provider Demographics
NPI:1417933342
Name:STERNBERG, MICHAEL G (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:STERNBERG
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 1:1107 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2894
Mailing Address - Country:US
Mailing Address - Phone:757-229-4222
Mailing Address - Fax:757-564-3422
Practice Address - Street 1:1107 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2894
Practice Address - Country:US
Practice Address - Phone:757-229-4222
Practice Address - Fax:757-564-3422
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA231451OtherMAMSI/ NITED HELATH CAR
VA075580OtherANTHEM, BLUE CROSS & BLUE
VA231451OtherMAMSI/ NITED HELATH CAR
VA075580OtherANTHEM, BLUE CROSS & BLUE