MEDICARE: BERKSHIRE EYE CARE PC

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

General Provider Information

NPI Number	:	1972935963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKSHIRE EYE CARE PC

Provider Business Mailing Address
First Line	:	7913 NARRAGANSETT AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1807
Country	:	US
Telephone Number	:	708-741-5950
Fax Number	:	708-741-5951

Provider Business Practice Location Address
First Line	:	7913 NARRAGANSETT AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1807
Country	:	US
Telephone Number	:	708-741-5950
Fax Number	:	708-741-5951

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT JAMES BERKSHIRE JR.
Credential	:	O.D.
Telephone Number	:	708-741-5950

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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