Healthcare Provider Details

I. General information

NPI: 1962266510
Provider Name (Legal Business Name): BERKELEY EYE INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BIRDSONG DR STE A
BAYTOWN TX
77521-3205
US

IV. Provider business mailing address

21502 MERCHANTS WAY
KATY TX
77449-2517
US

V. Phone/Fax

Practice location:
  • Phone: 281-422-2020
  • Fax: 281-422-4959
Mailing address:
  • Phone: 281-944-2232
  • Fax: 281-944-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK MICHELETTI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 281-348-4615