Healthcare Provider Details

I. General information

NPI: 1568442846
Provider Name (Legal Business Name): MARC GEORGE BERGERON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N MAYS ST
ROUND ROCK TX
78664-4317
US

IV. Provider business mailing address

408 N MAYS ST
ROUND ROCK TX
78664-4317
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-2003
  • Fax: 512-218-4743
Mailing address:
  • Phone: 512-244-2003
  • Fax: 512-218-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2584T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2584T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: