Provider Demographics
NPI:1245667054
Name:BERARDI EYECARE LLC
Entity type:Organization
Organization Name:BERARDI EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-983-6680
Mailing Address - Street 1:9601 MALL ROAD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-983-6680
Mailing Address - Fax:304-983-6681
Practice Address - Street 1:9601 MALL RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-8540
Practice Address - Country:US
Practice Address - Phone:304-983-6680
Practice Address - Fax:304-983-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1004-0706332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier