Provider Demographics
NPI:1336261205
Name:BERG EYE CENTER, P. C.
Entity Type:Organization
Organization Name:BERG EYE CENTER, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-432-7012
Mailing Address - Street 1:2709 MEREDYTH DR
Mailing Address - Street 2:SUITE 110 ONE MEREDYTH PLACE
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0201
Mailing Address - Country:US
Mailing Address - Phone:229-439-8002
Mailing Address - Fax:229-435-0211
Practice Address - Street 1:2709 MEREDYTH DR
Practice Address - Street 2:SUITE 110 ONE MEREDYTH PLACE
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0201
Practice Address - Country:US
Practice Address - Phone:229-439-8002
Practice Address - Fax:229-435-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021643332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1147520001Medicare NSC