Provider Demographics
NPI:1245639814
Name:DR JANA BERTKE OD PLLC
Entity type:Organization
Organization Name:DR JANA BERTKE OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-834-2050
Mailing Address - Street 1:PO BOX 42241
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-2241
Mailing Address - Country:US
Mailing Address - Phone:540-834-2050
Mailing Address - Fax:540-834-2444
Practice Address - Street 1:10001 SOUTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2700
Practice Address - Country:US
Practice Address - Phone:540-834-2050
Practice Address - Fax:540-834-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty