MEDICARE: DR. VICKI GOLDFARB BERGER 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	3458	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	311114688	OTHER	OH	TAX ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023151891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI GOLDFARB BERGER OD

Provider Business Mailing Address
First Line	:	2667 SAWBURY BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4582
Country	:	US
Telephone Number	:	614-764-0004
Fax Number	:	614-764-0042

Provider Business Practice Location Address
First Line	:	2667 SAWBURY BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4582
Country	:	US
Telephone Number	:	614-764-0004
Fax Number	:	614-764-0042

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/04/2016

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