Healthcare Provider Details

I. General information

NPI: 1699755850
Provider Name (Legal Business Name): WILLIAM M BERKE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 S HARBOR BLVD STE 104
SANTA ANA CA
92704-6857
US

IV. Provider business mailing address

3301 S HARBOR BLVD STE 104
SANTA ANA CA
92704-6857
US

V. Phone/Fax

Practice location:
  • Phone: 714-979-2021
  • Fax: 714-549-3367
Mailing address:
  • Phone: 714-979-2021
  • Fax: 714-549-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: