Provider Demographics
NPI:1255496030
Name:BERKSHIRE EYE CENTER, P.C.
Entity Type:Organization
Organization Name:BERKSHIRE EYE CENTER, P.C.
Other - Org Name:
Other - Org Type:
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 1:342 STOCKBRIDGE RD
Mailing Address - Street 2:KMART PLAZA
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1235
Mailing Address - Country:US
Mailing Address - Phone:413-528-8911
Mailing Address - Fax:413-528-2711
Practice Address - Street 1:342 STOCKBRIDGE RD
Practice Address - Street 2:KMART PLAZA
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1235
Practice Address - Country:US
Practice Address - Phone:413-528-8911
Practice Address - Fax:413-528-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16093OtherMEDICARE PIN DR G
MA9774017Medicaid
MAI22279OtherMEDICARE PIN-DR EVENCHIK
MAJ27719OtherMEDICARE PIN DR GINSBERG
MAJ09851OtherMEDICARE PIN DR O
MAJ03513OtherMEDICARE PIN DR S
MAJ03513OtherMEDICARE PIN DR S
MAI22279OtherMEDICARE PIN-DR EVENCHIK