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General NPI Number Information
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NPI Number | 1881528495
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Entity Type | Individual
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Provider Name | KRISTIN GOERTZ BERGSTROM
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Gender | Female
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 15655 PACIFIC ST STE 101
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City | OMAHA
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State | NE
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Zip | 68118-2114
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Country | US
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Telephone | 402-697-5122
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 N MAIN ST APT F
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City | ELKHORN
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State | NE
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Zip | 68022-4365
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 138173
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1693
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License Number State | NE
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