Provider Demographics
NPI:1710047329
Name:BERDING, ROBIN G (OD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:G
Last Name:BERDING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:105 GRAND CENTRAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4148
Practice Address - Country:US
Practice Address - Phone:912-450-9200
Practice Address - Fax:912-450-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001177152W00000X
FLOPC2705152W00000X
GAOPT001177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52295473OtherBLUE CROSS BLUE SHIELD GA
GA00477815AMedicaid
GAU28358Medicare UPIN
GA52295473OtherBLUE CROSS BLUE SHIELD GA