Provider Demographics
NPI:1164491825
Name:BERRY, MERLE NYE (OD)
Entity Type:Individual
Prefix:DR
First Name:MERLE
Middle Name:NYE
Last Name:BERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0058
Mailing Address - Country:US
Mailing Address - Phone:541-926-6077
Mailing Address - Fax:541-926-0605
Practice Address - Street 1:2300 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6800
Practice Address - Country:US
Practice Address - Phone:541-926-6077
Practice Address - Fax:541-926-0605
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1264AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR236109Medicaid
OR236109Medicaid
ORMB1079549OtherDRUG NUMBER
ORT67427Medicare UPIN