Provider Demographics
NPI:1013028224
Name:BERG, AMY J (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:BERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:5809 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2301
Practice Address - Country:US
Practice Address - Phone:571-290-6080
Practice Address - Fax:571-291-6081
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA618002108152W00000X
MN2523152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22/02562OtherMEDICA
MN513T3BEOtherBCBS
MN967725900Medicaid
MN410001983Medicare ID - Type Unspecified
MN513T3BEOtherBCBS