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Organization

BERKELEY EYE INSTITUTE, PLLC

Active
Other names
Berkeley Eye Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MARK F MICHELETTI (EXECUTIVE DIRECTOR)
(281) 348-4615
Entity
Organization

Contact information

Practice address
143 VISION PARK BLVD, SHENANDOAH, TX 77384-3001
(281) 363-3443
(936) 271-1351
Mailing address
143 VISION PARK BLVD, SHENANDOAH, TX 77384-3001
(281) 363-3443
(936) 271-1351

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
207W00000X
Ophthalmology Physician
Primary
332H00000X
Eyewear Supplier

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0072KD
BLUE CROSS BLUE SHIELD
TX
05
158559801
TX
Enumeration date
07/29/2008
Last updated
03/31/2023
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