Provider Demographics
NPI:1164562682
Name:BERZANSKY, MICHAEL JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BERZANSKY
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 1:175 MAIN ST SOUTH, STE 2
Mailing Address - Street 2:PO BOX 384
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798
Mailing Address - Country:US
Mailing Address - Phone:203-263-3391
Mailing Address - Fax:
Practice Address - Street 1:175 MAIN ST SOUTH, STE 2
Practice Address - Street 2:PO BOX 384
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798
Practice Address - Country:US
Practice Address - Phone:203-263-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001877152W00000X
NY007216152W00000X
SC1812152W00000X
CT3231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist