Healthcare Provider Details

I. General information

NPI: 1215950308
Provider Name (Legal Business Name): BERKELEY EYE INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 SOUTH WELLS STREET
EDNA TX
77957-4098
US

IV. Provider business mailing address

21502 MERCHANTS WAY STE A
KATY TX
77449-2515
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-5241
  • Fax: 361-782-7495
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 TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

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