Individual
BERT PEDERZOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1650 S UNION AVE, ALLIANCE, OH 44601-4349
(330) 630-9699
Mailing address
PO BOX 207170, DALLAS, TX 75320-2154
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3261
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000131061
ANTHEM BLUE CROSS BLUE SH
OH
05
—
0311219
—
OH
Enumeration date
12/05/2006
Last updated
06/08/2021
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