MEDICARE: DEBORAH RADELINE BEREDA 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	OPT004342	OH

General Provider Information

NPI Number	:	1275523029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH RADELINE BEREDA O.D.

Provider Business Mailing Address
First Line	:	15933 CLAYTON RD STE 210
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8118 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2935
Country	:	US
Telephone Number	:	513-860-5525
Fax Number	:	513-860-3313

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	01/05/2026

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