MEDICARE: DR. RONALD K BERGGREN O.D.

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	892	CO

General Provider Information

NPI Number	:	1144206657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD K BERGGREN O.D.

Provider Business Mailing Address
First Line	:	26 GOLDEN EAGLE LN
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80127-5742
Country	:	US
Telephone Number	:	303-979-3475
Fax Number	:	303-979-5124

Provider Business Practice Location Address
First Line	:	6565 W JEWELL AVE
Second Line	:	SUITE 7
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-7102
Country	:	US
Telephone Number	:	303-936-1671
Fax Number	:	303-936-6230

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2007

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