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NPI Code Detail

MEDICARE: BERG EN DAL PLLC

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
1152WC0802XCorneal and Contact Management Optometrist
2152W00000XOptometrist

General Provider Information

NPI Number : 1881787281
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERG EN DAL PLLC
Provider Business Mailing Address
First Line : 3601 W WILLIAM CANNON DR STE 150
Second Line :
City : AUSTIN
State : TX
Zip : 78749-1533
Country : US
Telephone Number : 512-441-8924
Fax Number : 512-442-4585
Provider Business Practice Location Address
First Line : 3601 W WILLIAM CANNON DR
Second Line : SUITE 150
City : AUSTIN
State : TX
Zip : 78749-1525
Country : US
Telephone Number : 512-441-8924
Fax Number : 512-442-4585
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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