Provider Demographics
NPI:1952490294
Name:BERKEN, SCOTT T (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:BERKEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0093
Mailing Address - Country:US
Mailing Address - Phone:360-533-1880
Mailing Address - Fax:360-533-1886
Practice Address - Street 1:301 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-3933
Practice Address - Country:US
Practice Address - Phone:360-533-1880
Practice Address - Fax:360-533-1886
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABE 9095OtherREGENCE
WA0803129OtherBLUECROSS
WA1023141Medicaid
WA91969OtherL & I PROV. #
WA410040935OtherRR MEDICARE
WA1023141Medicaid
WAGAB03099Medicare PIN