MEDICARE: AMY J BERG 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	618002108	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22/02562	OTHER	MN	MEDICA
2	513T3BE	OTHER	MN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013028224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY J BERG OD

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD STE 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	866-795-4020

Provider Business Practice Location Address
First Line	:	5809 LEESBURG PIKE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2301
Country	:	US
Telephone Number	:	571-290-6080
Fax Number	:	571-291-6081

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/28/2021

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