Provider Demographics
NPI:1538175567
Name:BERGMAN, CHRISTOPHER (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:BERGMAN
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 1:11606 NICHOLAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4478
Mailing Address - Country:US
Mailing Address - Phone:402-493-3712
Mailing Address - Fax:402-493-8341
Practice Address - Street 1:11606 NICHOLAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4478
Practice Address - Country:US
Practice Address - Phone:402-493-3712
Practice Address - Fax:402-493-8341
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084218401Medicaid
NE8589OtherMIDLANDS CHOICE
NE2200048OtherUNITED HEALTHCARE
NE36795OtherBLUE CROSS & BLUE SHIELD
IA1920041OtherIOWA MEDICAID
NE47084218401Medicaid
NE274226Medicare ID - Type Unspecified