Provider Demographics
NPI:1083833727
Name:CRAIG E. BERRIS
Entity Type:Organization
Organization Name:CRAIG E. BERRIS
Other - Org Name:CENTER FOR COSMETIC EYELID & LASER SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-929-6707
Mailing Address - Street 1:77 SCRIPPS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6209
Mailing Address - Country:US
Mailing Address - Phone:916-929-6707
Mailing Address - Fax:916-929-6897
Practice Address - Street 1:77 SCRIPPS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6209
Practice Address - Country:US
Practice Address - Phone:916-929-6707
Practice Address - Fax:916-929-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32698261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45253Medicare UPIN
CA00G326980Medicare ID - Type Unspecified