Healthcare Provider Details

I. General information

NPI: 1740362078
Provider Name (Legal Business Name): STEVEN LEE WASSERBURGER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 10TH ST SUITE B
GERING NE
69341-2409
US

IV. Provider business mailing address

1605 10TH ST SUITE B
GERING NE
69341-2409
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-3176
  • Fax: 308-436-9105
Mailing address:
  • Phone: 308-436-3176
  • Fax: 308-436-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number789
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: