Provider Demographics
NPI:1841525250
Name:NICOLE L. BERHOW, OD, INC.
Entity type:Organization
Organization Name:NICOLE L. BERHOW, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERHOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-258-6333
Mailing Address - Street 1:600 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:SUITE 136
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4162
Mailing Address - Country:US
Mailing Address - Phone:907-258-6333
Mailing Address - Fax:907-258-6968
Practice Address - Street 1:600 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:SUITE 136
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4162
Practice Address - Country:US
Practice Address - Phone:907-258-6333
Practice Address - Fax:907-258-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-03
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty