Provider Demographics
NPI:1427195270
Name:BERRIS OPTICAL OF ROCKY RIVER, INC.
Entity Type:Organization
Organization Name:BERRIS OPTICAL OF ROCKY RIVER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:HUDECEK
Authorized Official - Last Name:ZILLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-333-3138
Mailing Address - Street 1:21631 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3917
Mailing Address - Country:US
Mailing Address - Phone:440-333-3138
Mailing Address - Fax:440-356-3961
Practice Address - Street 1:21631 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3917
Practice Address - Country:US
Practice Address - Phone:440-333-3138
Practice Address - Fax:440-356-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0656780001Medicare UPIN
OH0656780001Medicare NSC