MEDICARE: DR. SETH M. BERG 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	OPC3084	FL

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

General Provider Information

NPI Number	:	1467454157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH M. BERG O.D.

Provider Business Mailing Address
First Line	:	1856 N NOB HILL RD
Second Line	:	#261
City	:	PLANTATION
State	:	FL
Zip	:	33322-6548
Country	:	US
Telephone Number	:	954-536-8905
Fax Number	:	954-370-4546

Provider Business Practice Location Address
First Line	:	1856 N NOB HILL RD
Second Line	:	#261
City	:	PLANTATION
State	:	FL
Zip	:	33322-6548
Country	:	US
Telephone Number	:	954-536-8905
Fax Number	:	954-370-4546

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	01/08/2015

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