Healthcare Provider Details

I. General information

NPI: 1679690929
Provider Name (Legal Business Name): WILLIAM A. BERRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 S GREEN RD
CLEVELAND OH
44121-3313
US

IV. Provider business mailing address

2183 S GREEN RD
CLEVELAND OH
44121-3313
US

V. Phone/Fax

Practice location:
  • Phone: 216-381-1466
  • Fax:
Mailing address:
  • Phone: 216-381-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number859 S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: