Provider Demographics
NPI:1093743056
Name:BERKOWITZ, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 S IH 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5703
Mailing Address - Country:US
Mailing Address - Phone:512-443-9715
Mailing Address - Fax:512-443-9845
Practice Address - Street 1:2610 S IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5703
Practice Address - Country:US
Practice Address - Phone:512-443-9715
Practice Address - Fax:512-443-9845
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2318207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX816484OtherBCBS
TX117173806Medicaid
TX8K9639OtherMEDICARE INDIVIDUAL PTAN
TX117173801Medicaid
180012855OtherRAILROAD MEDICARE
180012855OtherRAILROAD MEDICARE
TX816484OtherBCBS
TX117173801Medicaid
TX117173806Medicaid