Provider Demographics
NPI:1356334882
Name:KERBER, DEBORAH LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:KERBER
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 1:875 SAINT FRANCOIS ST
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4923
Mailing Address - Country:US
Mailing Address - Phone:314-839-2400
Mailing Address - Fax:314-839-2403
Practice Address - Street 1:875 SAINT FRANCOIS ST
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4923
Practice Address - Country:US
Practice Address - Phone:314-839-2400
Practice Address - Fax:314-839-2403
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03049152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318523602Medicaid
MO0325190001Medicare NSC
MOU33080Medicare UPIN
MO318523602Medicaid