Provider Demographics
NPI:1033388699
Name:MICHAEL L BERGER OD PC
Entity Type:Organization
Organization Name:MICHAEL L BERGER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-978-1199
Mailing Address - Street 1:6677 W THUNDERBIRD RD # B132
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3713
Mailing Address - Country:US
Mailing Address - Phone:602-978-1199
Mailing Address - Fax:
Practice Address - Street 1:6677 W THUNDERBIRD RD #B132
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3713
Practice Address - Country:US
Practice Address - Phone:602-978-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z71755Medicare PIN