Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA0679 | MD |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TA0679 | MD |
N | 152WP0200X | Pediatric Optomitrist | TA0679 | MD |
N | 152WS0006X | Sports Vision | TA0679 | MD |
N | 152WV0400X | Optomitrist - Vision Therapist | TA0679 | MD |
NPI | 1063448983 |
---|---|
Provider Name | Dr. Ronald Mark Berger |
First Address | Ellicott City, MD 21042-7711 |
Second Address | Ellicott City, MD 21042-7711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 09/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269818800 | (05) | MD |
T59931 | (02) | MD |