Provider Demographics
NPI:1144326174
Name:HERBOLSHEIMER, JOHN R (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HERBOLSHEIMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3906 TWIN CREEK DR
Mailing Address - Street 2:STE. 102
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4104
Mailing Address - Country:US
Mailing Address - Phone:402-932-8007
Mailing Address - Fax:402-932-8112
Practice Address - Street 1:3906 TWIN CREEK DR
Practice Address - Street 2:STE. 102
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4104
Practice Address - Country:US
Practice Address - Phone:402-932-8007
Practice Address - Fax:402-932-8112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025340600Medicaid
NE10026095700Medicaid
NE10026095700Medicaid