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General NPI Number Information
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NPI Number | 1417022773
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Entity Type | Individual
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Provider Name | MATTHEW GLEN BERARDI OD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3208 HUSKY HWY
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City | FARMINGTON
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State | WV
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Zip | 26571-8122
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Country | US
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Telephone | 304-825-6364
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Fax | 304-825-6750
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Provider Business Mailing Address
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Address Line | 3208 HUSKY HWY
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City | FARMINGTON
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State | WV
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Zip | 26571-8122
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Country | US
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Telephone | 304-825-6364
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Fax | 304-825-6750
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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 | 830-D
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License Number State | WV
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