Provider Demographics
NPI:1235293119
Name:BERKSHIRE EYE CENTER, P.C.
Entity Type:Organization
Organization Name:BERKSHIRE EYE CENTER, P.C.
Other - Org Name:KINDERHOOK EYE CENTER, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:EVENCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-445-4564
Mailing Address - Street 1:ROUTE 9
Mailing Address - Street 2:SUITE 402
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184
Mailing Address - Country:US
Mailing Address - Phone:518-758-9286
Mailing Address - Fax:518-758-7443
Practice Address - Street 1:ROUTE 9
Practice Address - Street 2:SUITE 402
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184
Practice Address - Country:US
Practice Address - Phone:518-758-9286
Practice Address - Fax:518-758-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1010050001Medicare NSC
MAM16029Medicare PIN