MEDICARE: ROGER L. BERGERON, O.D.P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410002654	OTHER	ME	RAIROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629249842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER L. BERGERON, O.D.P.A.

Provider Business Mailing Address
First Line	:	585 MAIN ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-5945
Country	:	US
Telephone Number	:	207-784-0153
Fax Number	:	207-786-6725

Provider Business Practice Location Address
First Line	:	585 MAIN ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-5945
Country	:	US
Telephone Number	:	207-784-0153
Fax Number	:	207-786-6725

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROGER L. BERGERON
Credential	:	O.D.
Telephone Number	:	207-784-0153

Provider Enumeration Date	:	03/15/2008
Last Update Date	:	03/15/2008

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Directions to “ROGER L. BERGERON, O.D.P.A. ” Practice Location

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