Provider Demographics
NPI:1013040831
Name:BERKSHIRE EYE CARE ,P.A.
Entity Type:Organization
Organization Name:BERKSHIRE EYE CARE ,P.A.
Other - Org Name:BERKSHIRE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYLOU
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-455-4500
Mailing Address - Street 1:7075 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6706
Mailing Address - Country:US
Mailing Address - Phone:239-455-4500
Mailing Address - Fax:239-354-4425
Practice Address - Street 1:7075 RADIO RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6706
Practice Address - Country:US
Practice Address - Phone:239-455-4500
Practice Address - Fax:239-354-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K8807Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER