Provider Demographics
NPI:1982699856
Name:BERMAN, MELVIN ROY (OD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:ROY
Last Name:BERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4908
Mailing Address - Country:US
Mailing Address - Phone:919-872-2020
Mailing Address - Fax:919-872-3207
Practice Address - Street 1:1601 E MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4908
Practice Address - Country:US
Practice Address - Phone:919-872-2020
Practice Address - Fax:919-872-3207
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909066Medicaid
NC8909066Medicaid
T64855Medicare UPIN