Organization Name: | BERKLEY EYEWEAR LLC |
NPI Number: | 1194020966 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LISA F GILBERT (OWNER) |
Mailing Address: | 2782 Coolidge Hwy Berkley |
State: | MI US |
Postal Code: | 480721557 |
Phone Number: | 2486296410 |
Fax Number: | 2486296411 |
NPI Enumeration Date: | 01/25/2011 |
NPI Last Update Date: | 01/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |