Provider Demographics
NPI:1720139850
Name:BERLIN FAMILY EYE CARE SC
Entity type:Organization
Organization Name:BERLIN FAMILY EYE CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-361-1696
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-0228
Mailing Address - Country:US
Mailing Address - Phone:920-361-1696
Mailing Address - Fax:920-361-1247
Practice Address - Street 1:269 MEMORIAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1243
Practice Address - Country:US
Practice Address - Phone:920-361-1696
Practice Address - Fax:920-361-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38455800Medicaid
WI4263520001Medicare NSC
WI000047680Medicare ID - Type Unspecified