NPIMap

Organization Active NPI

Berkeley Eye Institute, PLLC

Doing business as Berkeley Eye Center

  • Ophthalmology Physician
  • Edna, TX
National Provider Identifier
1215950308
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
BERKELEY EYE INSTITUTE, PLLC
Doing business as
Berkeley Eye Center
Practice address
1013 South Wells Street
Edna, TX 77957-4098
Phone
(361) 782-5241
Fax
(361) 782-7495
NPI assigned
Jul 26, 2006
Last updated
Mar 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark F Micheletti
Title
Executive Director
Phone
(281) 348-4615

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1013 South Wells Street
Edna, TX 77957-4098

Mailing address

21502 Merchants Way Ste a
Katy, TX 77449-2515
Phone (281) 944-2232

Other identifiers 2

IdentifierTypeStateIssuer
0072KDOtherTXBLUE CROSS BLUE SHIELD
158559801MedicaidTX

Other names 1

  • Berkeley Eye Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Berkeley Eye Institute PLLC23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

1013 S Wells St
Edna, TX 77957
Phone (361) 782-5241

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680220800000",
    "number": "1215950308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21502 MERCHANTS WAY STE A",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774492515",
            "telephone_number": "281-944-2232",
            "fax_number": "281-944-2290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 SOUTH WELLS STREET",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779574098",
            "telephone_number": "361-782-5241",
            "fax_number": "361-782-7495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERKELEY EYE INSTITUTE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A",
        "authorized_official_last_name": "MICHELETTI",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "281-348-4615"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0072KD",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158559801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkeley Eye Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Berkeley Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edna, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.