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General NPI Number Information
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NPI Number | 1164562682
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Entity Type | Individual
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Provider Name | MICHAEL JOHN BERZANSKY OD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 175 MAIN ST SOUTH, STE 2 PO BOX 384
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City | WOODBURY
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State | CT
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Zip | 06798
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Country | US
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Telephone | 203-263-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 175 MAIN ST SOUTH, STE 2 PO BOX 384
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City | WOODBURY
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State | CT
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Zip | 06798
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Country | US
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Telephone | 203-263-3391
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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 | 0EG001877
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 007216
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1812
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3231
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License Number State | CT
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