Provider Demographics
NPI:1578810594
Name:BERZINS, LAURA FONG (OD)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:FONG
Last Name:BERZINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 61ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4211
Mailing Address - Country:US
Mailing Address - Phone:718-680-8881
Mailing Address - Fax:
Practice Address - Street 1:240 E 46TH ST
Practice Address - Street 2:APT 9G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2956
Practice Address - Country:US
Practice Address - Phone:714-757-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007909152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist