Provider Demographics
NPI:1740400654
Name:BERKELY EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BERKELY EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKELY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-658-1781
Mailing Address - Street 1:142 ENCLAVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3208
Mailing Address - Country:US
Mailing Address - Phone:724-658-1781
Mailing Address - Fax:724-658-1923
Practice Address - Street 1:142 ENCLAVE DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3208
Practice Address - Country:US
Practice Address - Phone:724-658-1781
Practice Address - Fax:724-658-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102035975 0001Medicaid
PA0208990001Medicare NSC
PACB0450Medicare PIN
PA112649Medicare PIN