Healthcare Provider Details

I. General information

NPI: 1982600136
Provider Name (Legal Business Name): BERKS FAMILY EYECARE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E PENN AVE
WERNERSVILLE PA
19565-1613
US

IV. Provider business mailing address

247 E PENN AVE
WERNERSVILLE PA
19565-1613
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-7202
  • Fax: 610-678-9866
Mailing address:
  • Phone: 610-678-7202
  • Fax: 610-678-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOEG000172
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000172
License Number StatePA

VIII. Authorized Official

Name: KIMBERLY ANN MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-678-7202