Provider Demographics
NPI:1306738851
Name:REBERGER, BENJAMIN LEE III (OD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:REBERGER
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:REBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:239 SOUTHGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7768
Mailing Address - Country:US
Mailing Address - Phone:812-605-1448
Mailing Address - Fax:
Practice Address - Street 1:800 E ATWATER AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3635
Practice Address - Country:US
Practice Address - Phone:812-605-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program