Provider Demographics
NPI:1992777031
Name:VERBECK, CHRISTINE M (O D)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:VERBECK
Suffix:
Gender:F
Credentials:O D
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:VERBECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:111 S RED BANK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-6526
Mailing Address - Country:US
Mailing Address - Phone:812-423-4984
Mailing Address - Fax:812-423-5029
Practice Address - Street 1:111 S RED BANK RD STE A
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6509
Practice Address - Country:US
Practice Address - Phone:812-423-4984
Practice Address - Fax:812-423-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009184Medicaid
IN000000604105OtherANTHEM HEC
IN200929290AMedicaid
IN259940AMedicare PIN
IN200929290AMedicaid
INU75751Medicare UPIN
ILIL1077002Medicare PIN
ILIL8307001Medicare PIN
IL046009184Medicaid
INP00893784Medicare PIN