Provider Demographics
NPI:1346678828
Name:BERT EYE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:BERT EYE MEDICAL GROUP, INC
Other - Org Name:BERT EYE MEDICAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-433-1600
Mailing Address - Street 1:490 POST ST
Mailing Address - Street 2:SUITE 933
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1401
Mailing Address - Country:US
Mailing Address - Phone:415-433-1600
Mailing Address - Fax:415-834-1444
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 933
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1401
Practice Address - Country:US
Practice Address - Phone:415-433-1600
Practice Address - Fax:415-834-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty