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General NPI Number Information
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NPI Number | 1346082872
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Entity Type | Organization
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Legal Business Name | BERKELEY EYE INSTITUTE, PLLC
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 306 N MAIN ST STE A
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City | DAYTON
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State | TX
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Zip | 77535-2635
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Country | US
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Telephone | 936-258-0020
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Fax | 936-257-8111
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Provider Business Mailing Address
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Address Line | 306 N MAIN ST STE A
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City | DAYTON
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State | TX
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Zip | 77535-2635
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Country | US
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Telephone | 936-258-0020
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Fax | 936-257-8111
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARK MICHELETTI
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Credential |
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Telephone | 281-348-4615
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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