Provider Demographics
NPI:1154325686
Name:BERKSHIRE EYE SURGERY CENTER LP
Entity Type:Organization
Organization Name:BERKSHIRE EYE SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-736-0144
Mailing Address - Street 1:2220 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1167
Mailing Address - Country:US
Mailing Address - Phone:610-736-0144
Mailing Address - Fax:610-736-0926
Practice Address - Street 1:2220 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1167
Practice Address - Country:US
Practice Address - Phone:610-736-0144
Practice Address - Fax:610-736-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15291501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057053Medicare Oscar/Certification