MEDICARE: DR. KRYSTAL LEIGH BERTHELETTE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1415	SC

General Provider Information

NPI Number	:	1003921180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTAL LEIGH BERTHELETTE OD

Provider Business Mailing Address
First Line	:	119 LATONEA DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-7572
Country	:	US
Telephone Number	:	803-798-8642
Fax Number	:	803-798-8642

Provider Business Practice Location Address
First Line	:	5420 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-5401
Country	:	US
Telephone Number	:	803-790-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1285651448 — WAL-MART STORES EAST LP
Practice Location Address:

5420 FOREST DR
COLUMBIA, SC
29206-5401

Practice Phone: 803-782-8428
Practice Fax:

1306863576 — SAMS EAST INC
Practice Location Address:

5426 FOREST DR
COLUMBIA, SC
29206-5401

Practice Phone: 803-790-7284
Practice Fax:

1205934445 — SAM'S CLUB OPTICAL
Practice Location Address:

5426 FOREST DR
COLUMBIA, SC
29206-5401

Practice Phone: 803-790-1581
Practice Fax:

1093804908 — WAL-MART STORES EAST, LP
Practice Location Address:

5420 FOREST DR
COLUMBIA, SC
29206-5401

Practice Phone: 803-782-0323
Practice Fax:

1043513542 — PALMETTO STATE EYECARE, LLC
Practice Location Address:

5426 FOREST DR
COLUMBIA, SC
29206-5401

Practice Phone: 803-767-9964
Practice Fax: 803-790-2163

1811324445 — JILL MARIE MILLER PHARMD
Practice Location Address:

5426 FOREST DR
COLUMBIA, SC
29206-5401

Practice Phone: 803-790-7273
Practice Fax: 803-790-7284

Directions to “ DR. KRYSTAL LEIGH BERTHELETTE OD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.