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General NPI Number Information
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NPI Number | 1134443427
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Entity Type | Individual
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Provider Name | REBECCA A BERRY O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 4800 N 22ND ST
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City | PHOENIX
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State | AZ
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Zip | 85016-4701
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Country | US
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Telephone | 602-955-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 N 22ND ST
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City | PHOENIX
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State | AZ
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Zip | 85016-4701
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Country | US
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Telephone |
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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 | 046.010060
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License Number State | IL
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