Provider Demographics
NPI:1427212380
Name:HARBERTS, CALLIE E (OD)
Entity Type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:E
Last Name:HARBERTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CALLIE
Other - Middle Name:E
Other - Last Name:SPARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3820 N 27TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3234
Mailing Address - Country:US
Mailing Address - Phone:406-587-1245
Mailing Address - Fax:
Practice Address - Street 1:3820 N 27TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3234
Practice Address - Country:US
Practice Address - Phone:406-587-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003531A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200952720Medicaid
IN669220CMedicare PIN
INP00767419Medicare PIN
INM400037147Medicare PIN