Healthcare Provider Details

I. General information

NPI: 1972157774
Provider Name (Legal Business Name): MYEYEDR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E MAIN ST
MIDDLETOWN DE
19709-1449
US

IV. Provider business mailing address

223 E MAIN ST
MIDDLETOWN DE
19709-1449
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-1900
  • Fax:
Mailing address:
  • Phone: 484-620-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ZEFANNE P BERGADO
Title or Position: OPTOMETRIST
Credential: OD
Phone: 484-620-5347