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General NPI Number Information
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NPI Number | 1235245259
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Entity Type | Organization
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Legal Business Name | JAMES K. BERRY OD, PA
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1320 SHELFER ST
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City | LEESBURG
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State | FL
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Zip | 34748-3929
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Country | US
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Telephone | 352-787-9799
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Fax | 352-728-0057
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Provider Business Mailing Address
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Address Line | 1320 SHELFER ST
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City | LEESBURG
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State | FL
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Zip | 34748-3929
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Country | US
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Telephone | 352-787-9799
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Fax | 352-728-0057
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JAMES KEVIN BERRY
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Credential | O.D.
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Telephone | 352-787-9799
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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 | OPC1901
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License Number State | FL
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