MEDICARE: MR. DOUGLAS T BERGER OPTICIAN

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	156FC0800X	Contact Lens Technician/Technologist	C005104-1	NY
2	156FC0801X	Contact Lens Fitter	C005104-1	NY
3	156FX1800X	Optician	C005104-1	NY

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	:	1992862163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS T BERGER OPTICIAN

Provider Business Mailing Address
First Line	:	160 SHERMAN AVE
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-4123
Country	:	US
Telephone Number	:	917-553-7708
Fax Number	:

Provider Business Practice Location Address
First Line	:	2169 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1405
Country	:	US
Telephone Number	:	718-409-2200
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	09/21/2011

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