Anne Elizabeth Berk, O.D.
Individual provider Active NPI Optometrist · Happy Valley, OR
NPI 1609920701 · NPPES record last updated Aug 14, 2018
Key facts
- NPI
- 1609920701
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1749ATI (OR)
- Practice address
- 13180 SE 169TH Ave Ste 104
Happy Valley, OR 97086-8727 - Phone
- (503) 698-2375
- Fax
- (503) 698-3398
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111020000783 | OR | Practitioner - Optometry | 9931275773 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1749ATI | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Double Vision Inc | Optometrist | Current |
Accepting new patients |
| Spectrum Eye Care LLC | Optometrist | Current |
Accepting new patients |
Locations
12020 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 698-2375
13180 SE 169th Ave
Ste 104
Happy Valley, OR 97086
Phone (503) 252-2375
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1749ATI | OR | Yes |
Addresses
Primary practice location
13180 SE 169TH Ave Ste 104
Happy Valley, OR 97086-8727
Mailing address
13180 SE 169TH Ave Ste 104
Happy Valley, OR 97086-8727
Phone (503) 698-2375
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1749ATI | Other | OR | OD LICENSE NUMBER |
| 120345 | Medicaid | OR | |
| 1508037607 | Other | ORGANIZATIONAL (GROUP) NPI | |
| R0000WDBCW | Other | MEDICARE GROUP PIN |
Other providers in Happy Valley, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.