Provider Demographics
NPI:1972157774
Name:MYEYEDR.
Entity Type:Organization
Organization Name:MYEYEDR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ZEFANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERGADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:484-620-5347
Mailing Address - Street 1:223 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1449
Mailing Address - Country:US
Mailing Address - Phone:484-620-5347
Mailing Address - Fax:
Practice Address - Street 1:223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1449
Practice Address - Country:US
Practice Address - Phone:302-376-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty