Provider Demographics
NPI:1831132349
Name:BERG, JOHN THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:BERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:287 COUNTY ROAD 4749
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-5585
Mailing Address - Country:US
Mailing Address - Phone:254-542-7540
Mailing Address - Fax:254-542-7541
Practice Address - Street 1:2724 E HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2562
Practice Address - Country:US
Practice Address - Phone:254-542-7540
Practice Address - Fax:254-542-7541
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2915T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist