MEDICARE: BERKELEY EYE INSTITUTE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier
3	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0072KD	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497778583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKELEY EYE INSTITUTE, PLLC

Provider Business Mailing Address
First Line	:	21502 MERCHANTS WAY STE A
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-2515
Country	:	US
Telephone Number	:	281-944-2232
Fax Number	:	281-944-2290

Provider Business Practice Location Address
First Line	:	2012 WEST LOOP
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-8030
Country	:	US
Telephone Number	:	979-543-6821
Fax Number	:	979-543-6817

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARK F MICHELETTI
Credential	:
Telephone Number	:	281-348-4615

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/31/2023

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