Provider Demographics
NPI:1275630808
Name:BERK, WILLIAM BERT JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BERT
Last Name:BERK
Suffix:JR
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 1:13180 SE 169TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8727
Mailing Address - Country:US
Mailing Address - Phone:503-698-2375
Mailing Address - Fax:503-698-3398
Practice Address - Street 1:13180 SE 169TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-698-2375
Practice Address - Fax:503-698-3398
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1623ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508037607OtherORGANIZATION (GROUP) NPI
R0000WDBCWOtherMEDICARE GROUP PIN
R0000WDBCWOtherMEDICARE GROUP PIN