MEDICARE: BERG EN DAL PLLC

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	152WC0802X	Corneal and Contact Management Optometrist
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1740373141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERG EN DAL PLLC

Provider Business Mailing Address
First Line	:	2407 S CONGRESS AVE STE 100A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5506
Country	:	US
Telephone Number	:	512-442-2308
Fax Number	:	512-445-4546

Provider Business Practice Location Address
First Line	:	2407 S CONGRESS AVE STE 100A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5505
Country	:	US
Telephone Number	:	512-442-2308
Fax Number	:	512-445-4546

Authorized Official
Title or Position	:	OD
Name	:	SALLY SALAMATA HAMISSOU
Credential	:
Telephone Number	:	512-442-2308

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	12/17/2025

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