Organization
ROGER L. BERGERON, O.D.P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER L. BERGERON O.D. (PRESIDENT)
(207) 784-0153
Entity
Organization
Contact information
Practice address
585 MAIN ST, LEWISTON, ME 04240-5945
(207) 784-0153
(207) 786-6725
Mailing address
585 MAIN ST, LEWISTON, ME 04240-5945
(207) 784-0153
(207) 786-6725
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114880099
—
ME
01
—
410002654
RAIROAD MEDICARE
ME
Enumeration date
03/15/2008
Last updated
03/15/2008
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