Provider Demographics
NPI:1740362078
Name:WASSERBURGER, STEVEN LEE (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:WASSERBURGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1605 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2409
Mailing Address - Country:US
Mailing Address - Phone:308-436-3176
Mailing Address - Fax:308-436-9105
Practice Address - Street 1:1605 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-2409
Practice Address - Country:US
Practice Address - Phone:308-436-3176
Practice Address - Fax:308-436-9105
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083709300Medicaid
NE789OtherPROFESSIONAL LICENSE NUM
NE36782OtherBLUE CROSS/BLUE SHIELD
NET40275Medicare UPIN
NE1437154705Medicare PIN
NE36782OtherBLUE CROSS/BLUE SHIELD