Provider Demographics
NPI:1275642878
Name:BERKOWITZ, CARL GARY
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:GARY
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8658 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:MC KEAN
Mailing Address - State:PA
Mailing Address - Zip Code:16426-1226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7360 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-4711
Practice Address - Country:US
Practice Address - Phone:814-868-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA005205-P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72387Medicare UPIN
PA35396Medicare ID - Type Unspecified