Provider Demographics
NPI:1992740302
Name:BERKSHIRE EYE CENTER PC
Entity type:Organization
Organization Name:BERKSHIRE EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-445-4564
Mailing Address - Street 1:740 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7463
Mailing Address - Country:US
Mailing Address - Phone:413-445-4564
Mailing Address - Fax:413-448-2727
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7463
Practice Address - Country:US
Practice Address - Phone:413-445-4564
Practice Address - Fax:413-448-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9774017Medicaid
MA9774017Medicaid
NYA100078204Medicare PIN