Provider Demographics
NPI:1326012386
Name:BERG, SARAH ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELAINE
Last Name:BERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:FLORIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:433 SPORTSPLEX DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5358
Practice Address - Country:US
Practice Address - Phone:512-858-0020
Practice Address - Fax:512-858-2720
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6568TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1775157Medicaid
8F23173Medicare PIN
TX8L5656Medicare PIN