Provider Demographics
NPI:1457307860
Name:BERGES, GERALD F (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:F
Last Name:BERGES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2631
Mailing Address - Country:US
Mailing Address - Phone:509-783-8383
Mailing Address - Fax:509-735-2592
Practice Address - Street 1:4015 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2631
Practice Address - Country:US
Practice Address - Phone:509-783-8383
Practice Address - Fax:509-735-2592
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT86881Medicare UPIN
8802503Medicare PIN