Provider Demographics
NPI:1245294172
Name:BERKELY, MARILYN K (OD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:K
Last Name:BERKELY
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 1:142 ENCLAVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3208
Mailing Address - Country:US
Mailing Address - Phone:724-658-1781
Mailing Address - Fax:724-658-1923
Practice Address - Street 1:142 ENCLAVE DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3208
Practice Address - Country:US
Practice Address - Phone:724-658-1781
Practice Address - Fax:724-658-1923
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5266203OtherAETNA
PA102035975-0001Medicaid
PA25-1548092OtherVISION BENEFITS OF AMERIC
PA25-1548092OtherVISION SERVICE PLAN
PAT29203Medicare UPIN
PA25-1548092OtherVISION BENEFITS OF AMERIC
PA410010440Medicare PIN
PA102035975-0001Medicaid