Provider Demographics
NPI:1326018870
Name:BERRY, STUART RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:RAYMOND
Last Name:BERRY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:3635 S SONCY RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6402
Practice Address - Country:US
Practice Address - Phone:806-359-5900
Practice Address - Fax:806-359-5353
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX5611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU90882Medicare UPIN
TX8C1063Medicare PIN