MEDICARE: MR. RICHARD WILLIAM BERGIDA DO

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	156FX1800X	Optician	DO 1387	FL

General Provider Information

NPI Number	:	1053425488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD WILLIAM BERGIDA DO

Provider Business Mailing Address
First Line	:	1715 S FEDERAL HWY
Second Line	:	SUITE C-1
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3329
Country	:	US
Telephone Number	:	561-276-5099
Fax Number	:	561-274-9697

Provider Business Practice Location Address
First Line	:	1715 S FEDERAL HWY
Second Line	:	SUITE C-1
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3329
Country	:	US
Telephone Number	:	561-276-5099
Fax Number	:	561-274-9697

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	06/25/2008

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