Provider Demographics
NPI:1154644730
Name:MICHAEL P. BERT, O.D. P.C.
Entity Type:Organization
Organization Name:MICHAEL P. BERT, O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-432-5668
Mailing Address - Street 1:1950 SHERIDAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2548
Mailing Address - Country:US
Mailing Address - Phone:847-432-5668
Mailing Address - Fax:847-432-5680
Practice Address - Street 1:1950 SHERIDAN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2548
Practice Address - Country:US
Practice Address - Phone:847-432-5668
Practice Address - Fax:847-432-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63379Medicare UPIN
ILIL3906Medicare PIN