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General NPI Number Information
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NPI Number | 1033388699
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Entity Type | Organization
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Legal Business Name | MICHAEL L BERGER OD PC
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 6677 W THUNDERBIRD RD #B132
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City | GLENDALE
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State | AZ
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Zip | 85306-3713
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Country | US
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Telephone | 602-978-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 6677 W THUNDERBIRD RD # B132
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City | GLENDALE
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State | AZ
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Zip | 85306-3713
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Country | US
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Telephone | 602-978-1199
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | CAROL A. MILLER
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Credential |
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Telephone | 602-978-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | AZ0340
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License Number State | AZ
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