Provider Demographics
NPI:1487681284
Name:BERMAN, ANDREW MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:BERMAN
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 1:833 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4158
Mailing Address - Country:US
Mailing Address - Phone:302-674-1121
Mailing Address - Fax:302-674-3891
Practice Address - Street 1:833 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4158
Practice Address - Country:US
Practice Address - Phone:302-674-1121
Practice Address - Fax:302-674-3891
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001136152W00000X
MDTA0661152W00000X
PAOE004862P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE430675ZAPWMedicare PIN
MD49888003OtherDAVIS
MDT6180001OtherCFBCBS NASCO
MDT268952Medicare UPIN
MD920L379EMedicare PIN
MDX171Medicare PIN
MD54892707OtherCAREFIRST BCBSMD
MD130562OtherEYEMED