Healthcare Provider Details

I. General information

NPI: 1275642878
Provider Name (Legal Business Name): DR. CARL GARY BERKOWITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7360 PEACH ST
ERIE PA
16509-4711
US

IV. Provider business mailing address

8658 MAYFAIR DR
MC KEAN PA
16426-1226
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number005205-P
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: