Provider Demographics
NPI:1689101263
Name:BERENJIAN, NEDA
Entity Type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:BERENJIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 GEDDES AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2716
Mailing Address - Country:US
Mailing Address - Phone:734-904-4212
Mailing Address - Fax:
Practice Address - Street 1:3076 GEDDES AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2716
Practice Address - Country:US
Practice Address - Phone:734-904-4212
Practice Address - Fax:734-904-4212
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist