Provider Demographics
NPI:1578538872
Name:BERRY, STEVEN M (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:BERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5343 WYOMING BLVD NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3199
Mailing Address - Country:US
Mailing Address - Phone:505-332-2020
Mailing Address - Fax:505-856-7820
Practice Address - Street 1:5343 WYOMING BLVD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3199
Practice Address - Country:US
Practice Address - Phone:505-332-2020
Practice Address - Fax:505-332-8343
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95982035Medicare ID - Type Unspecified
NMU87096Medicare UPIN
NM345507005Medicare ID - Type Unspecified