Provider Demographics
NPI:1093913139
Name:BERRYHILL EYE CARE INC
Entity Type:Organization
Organization Name:BERRYHILL EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JOLYNDA
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-292-7062
Mailing Address - Street 1:9237 GREENSBORO CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7438
Mailing Address - Country:US
Mailing Address - Phone:850-292-7062
Mailing Address - Fax:
Practice Address - Street 1:9237 GREENSBORO CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7438
Practice Address - Country:US
Practice Address - Phone:850-292-7062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE783OtherMEDICARE
9037065OtherAETNA
FL6130220001Medicare NSC