NPIMap

Organization Active NPI

Berkeley Eye Institute, PLLC

  • Ophthalmology Physician
  • El Campo, TX
National Provider Identifier
1497778583
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
Practice address
2012 West Loop
El Campo, TX 77437-8030
Phone
(979) 543-6821
Fax
(979) 543-6817
NPI assigned
Jul 26, 2006
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

2012 West Loop
El Campo, TX 77437-8030

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505001572 TX Part B Supplier - Clinic/Group Practice 4082602156 Receives reassigned benefits from 72 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Houston, TX; Humble, TX; Huntsville, TX; Katy, TX; Kingwood, TX; Lake Jackson, TX; Pearland, TX; Shenandoah, TX…
O20100930074884 TX DME Supplier - Physician - OptometristDME Supplier - Physician - Ophthalmology 4082602156 Practice locations: El Campo, TX

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Berkeley Eye Center2012 West Loop, El Campo, TX 77437-8030(979) 543-6821 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jul 1, 2003

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2012 West Loop
El Campo, TX 77437
Phone (979) 543-6821

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1497778583",
    "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": "2012 WEST LOOP",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774378030",
            "telephone_number": "979-543-6821",
            "fax_number": "979-543-6817"
        }
    ],
    "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
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 El Campo, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.