Basic Information
| Provider Information | |||||||||
| NPI: | 1538175567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGMAN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11606 NICHOLAS ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681544478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024933712 | ||||||||
| FaxNumber: | 4024938341 | ||||||||
| Practice Location | |||||||||
| Address1: | 11606 NICHOLAS ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681544478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024933712 | ||||||||
| FaxNumber: | 4024938341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1021 | NE | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 47084218401 | 05 | NE | MEDICAID | 8589 | 01 | NE | MIDLANDS CHOICE | OTHER | 2200048 | 01 | NE | UNITED HEALTHCARE | OTHER | 36795 | 01 | NE | BLUE CROSS & BLUE SHIELD | OTHER | 1920041 | 01 | IA | IOWA MEDICAID | OTHER |