Individual
BERT PEDERZOL
Active
Individual
BERT PEDERZOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
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
Update your record
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