Provider Demographics
NPI:1679566020
Name:NEBEKER, NEIL ROSS (OD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ROSS
Last Name:NEBEKER
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 1:197 W EL PORTAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2850
Mailing Address - Country:US
Mailing Address - Phone:209-384-2110
Mailing Address - Fax:209-384-8756
Practice Address - Street 1:197 W EL PORTAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2849
Practice Address - Country:US
Practice Address - Phone:209-722-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7293TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8653714Medicaid
CA8653714Medicaid
CA0281230001Medicare NSC
CAMN0650350OtherDEA NUMBER
CA8653714Medicaid