Provider Demographics
NPI:1306892971
Name:SICKBERT, STEVE R (OD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:R
Last Name:SICKBERT
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 1:620 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1319
Mailing Address - Country:US
Mailing Address - Phone:765-932-5553
Mailing Address - Fax:765-932-1813
Practice Address - Street 1:620 E 11TH ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1319
Practice Address - Country:US
Practice Address - Phone:765-932-5553
Practice Address - Fax:765-932-1813
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001939-IN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100215980AMedicaid
IN4959260001Medicare NSC
IN100215980AMedicaid
710490Medicare PIN