Provider Demographics
NPI:1104364256
Name:BERGSTROM, REECE E (DO)
Entity Type:Individual
Prefix:
First Name:REECE
Middle Name:E
Last Name:BERGSTROM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8116
Mailing Address - Fax:614-293-5315
Practice Address - Street 1:915 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-293-8116
Practice Address - Fax:614-293-5315
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2022-06-30
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Provider Licenses
StateLicense IDTaxonomies
OH34.015071207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology