Provider Demographics
NPI:1104905538
Name:FORGEY, DEAN RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:RUSSELL
Last Name:FORGEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S 70TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1566
Mailing Address - Country:US
Mailing Address - Phone:402-483-2323
Mailing Address - Fax:402-483-6184
Practice Address - Street 1:1520 S 70TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1566
Practice Address - Country:US
Practice Address - Phone:402-483-2323
Practice Address - Fax:402-483-6184
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17525207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0747401-00Medicaid
90112FOMedicare ID - Type Unspecified
NE47-0747401-00Medicaid