Provider Demographics
NPI:1740398437
Name:MICHAEL S. BERK, O.D. INC.
Entity type:Organization
Organization Name:MICHAEL S. BERK, O.D. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:OD,FAAO
Authorized Official - Phone:614-476-2015
Mailing Address - Street 1:951 E JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1851
Mailing Address - Country:US
Mailing Address - Phone:614-476-2015
Mailing Address - Fax:614-428-9856
Practice Address - Street 1:951 E JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1851
Practice Address - Country:US
Practice Address - Phone:614-476-2015
Practice Address - Fax:614-428-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9930792Medicare PIN
OH0559610002Medicare NSC