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General NPI Number Information
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NPI Number | 1073677886
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Entity Type | Individual
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Provider Name | BRIAN PAUL BERRY O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1243 W BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1509
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Country | US
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Telephone | 630-679-0900
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Fax | 630-679-0213
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Provider Business Mailing Address
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Address Line | 8628 KOEHLER DR
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City | TINLEY PARK
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State | IL
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Zip | 60477-8629
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Country | US
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Telephone | 708-633-4621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046-009359
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License Number State | IL
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