Healthcare Provider Details

I. General information

NPI: 1316526148
Provider Name (Legal Business Name): ERICH J BERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W 14TH ST STE 100A
JEFFERSONVILLE IN
47130-3751
US

IV. Provider business mailing address

550 SOUTH JACKSON STREET ACB, 3RD FLOOR
LOUISVILLE KY
40202
US

V. Phone/Fax

Practice location:
  • Phone: 812-284-0660
  • Fax: 812-284-3822
Mailing address:
  • Phone: 502-852-5666
  • Fax: 502-852-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number02008197A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: