Provider Demographics
NPI:1134299688
Name:BERGER-MOSCOW, SHARON (OD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:BERGER-MOSCOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 GRIMES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3930
Mailing Address - Country:US
Mailing Address - Phone:770-992-7620
Mailing Address - Fax:770-992-8262
Practice Address - Street 1:1190 GRIMES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3930
Practice Address - Country:US
Practice Address - Phone:770-992-7620
Practice Address - Fax:770-992-8262
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA925-T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22197Medicare UPIN