Provider Demographics
NPI:1881647568
Name:BORSKY-BERKO, BETTY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:LYNN
Last Name:BORSKY-BERKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:BORSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2016 BAY DR APT 503
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4421
Mailing Address - Country:US
Mailing Address - Phone:305-283-6989
Mailing Address - Fax:305-821-5271
Practice Address - Street 1:7535 WEST 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-821-3832
Practice Address - Fax:305-821-5271
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3916ZMedicare ID - Type Unspecified