Provider Demographics
NPI:1528018199
Name:HORNBERGER, SAMANTHA (OD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HORNBERGER
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 1:24173 STATELINE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7351
Mailing Address - Country:US
Mailing Address - Phone:859-283-0068
Mailing Address - Fax:859-283-1096
Practice Address - Street 1:24173 STATELINE RD
Practice Address - Street 2:STE 200
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-7351
Practice Address - Country:US
Practice Address - Phone:859-283-0068
Practice Address - Fax:859-283-1096
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003378B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000539394OtherANTHEM
IN0525160001Medicare NSC
IN000000539394OtherANTHEM
IN967140Medicare PIN