Provider Demographics
NPI:1346373453
Name:MICHAEL S BERK OD INC
Entity Type:Organization
Organization Name:MICHAEL S BERK OD INC
Other - Org Name:BERK EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:OD,FAAO
Authorized Official - Phone:614-866-9002
Mailing Address - Street 1:5180 E. MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2436
Mailing Address - Country:US
Mailing Address - Phone:614-866-9002
Mailing Address - Fax:614-866-3581
Practice Address - Street 1:5180 E MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2436
Practice Address - Country:US
Practice Address - Phone:614-866-9002
Practice Address - Fax:614-866-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9930791Medicare PIN
OH0559610001Medicare NSC