Provider Demographics
NPI:1225173917
Name:STEINBERG, DEBORAH ELLEN (OD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN
Last Name:STEINBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1544
Mailing Address - Country:US
Mailing Address - Phone:209-575-2020
Mailing Address - Fax:209-758-5693
Practice Address - Street 1:3605 HOSPITAL RD STE A
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5173
Practice Address - Country:US
Practice Address - Phone:209-726-1235
Practice Address - Fax:209-758-5693
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9099-TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225173917Medicaid
CA1225173917Medicaid
CAMS1136729OtherDEA
CA1225173917Medicaid
CASD0090991Medicare PIN
CABJ026ZMedicare PIN
CABJ026VMedicare PIN
CABJ026UMedicare PIN
CABJ026YMedicare PIN