Provider Demographics
NPI:1518045921
Name:BIBERDORF, DAVID HENRY (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENRY
Last Name:BIBERDORF
Suffix:
Gender:M
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:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:928-729-8000
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE N12 AND N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2023152W00000X
ND470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN308723900Medicaid
59775BIOtherBLUE PLUS OF MN
60081OtherND DEPT OF HUMAN
60397OtherVOCATIONAL REHAB CENTER
140630OtherU CARE MN
2200440OtherMEDICA
MN59775BIOtherBCBS MN
BIB800470OtherVISION SERVICES INC
410016499OtherMEDICARE RAILROAD
MD60397Medicaid
BIB8881OtherBLUE SHIELD OF ND VISION
308723900OtherMN DEPT OF HUMAN
59775BIOtherMN COMPREHENSIVE CARE
NDBIB8881OtherBCBS ND
BIB8881OtherBLUE SHIELD OF ND ALTRU
59775BIOtherBLUE PLUS OF MN