Provider Demographics
NPI:1699819151
Name:BERKSHIRE, ROBERT JAMES JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:BERKSHIRE
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7913 NARRAGANSETT AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1807
Mailing Address - Country:US
Mailing Address - Phone:708-741-5950
Mailing Address - Fax:708-741-5951
Practice Address - Street 1:7913 NARRAGANSETT AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1807
Practice Address - Country:US
Practice Address - Phone:708-741-5950
Practice Address - Fax:708-741-5951
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU53237Medicare UPIN