Individual
AMY J BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
618002108
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22/02562
MEDICA
MN
01
—
513T3BE
BCBS
MN
05
—
967725900
—
MN
Enumeration date
08/31/2006
Last updated
09/28/2021
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