Healthcare Provider Details

I. General information

NPI: 1235304312
Provider Name (Legal Business Name): BERGMAN EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHAMPION DR SUITE 101
HAGERSTOWN MD
21740-6558
US

IV. Provider business mailing address

220 CHAMPION DR STE 101
HAGERSTOWN MD
21740-6665
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-0888
  • Fax: 301-791-3611
Mailing address:
  • Phone: 301-791-0888
  • Fax: 301-791-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PASCETTA
Title or Position: CFO
Credential:
Phone: 860-652-5002