Provider Demographics
NPI:1972848455
Name:BERKELEY EYE INSTITUTE, PLLC
Entity Type:Organization
Organization Name:BERKELEY EYE INSTITUTE, PLLC
Other - Org Name:BERKELEY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:MICHELETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-348-4615
Mailing Address - Street 1:8731 KATY FWY STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1734
Mailing Address - Country:US
Mailing Address - Phone:713-827-8311
Mailing Address - Fax:713-827-7488
Practice Address - Street 1:8731 KATY FWY STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1734
Practice Address - Country:US
Practice Address - Phone:713-827-8311
Practice Address - Fax:713-827-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty