Individual provider Active NPI

Mark Daniel Berry

  • Student in an Organized Health Care Education/Training Program
  • Lubbock, TX
National Provider Identifier
1639817497
Registry record updated Apr 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
BP10080216 Issued in TX
Practice address
Department of Ophthalmology 3601 4TH St
Lubbock, TX 79430-0001
Phone
(806) 743-2020
NPI assigned
May 23, 2022
Last updated
Apr 12, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X BP10080216 TX Primary
Ophthalmology Physician 207W00000X W4419 TX

Addresses

Primary practice location

Department of Ophthalmology 3601 4TH St
Lubbock, TX 79430-0001

Mailing address

Department of Ophthalmology 3601 4TH St
Lubbock, TX 79430-0001
Phone (806) 743-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11601 Toepperwein Rd
Live Oak, TX 78233-3403

715 Twining Rd
Suite 108
Dresher, PA 19025-1884

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
W4419TXMDOphthalmology Physician
BP10080216TXMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775952000000",
    "number": "1639817497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF OPHTHALMOLOGY 3601 4TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794300001",
            "telephone_number": "806-743-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF OPHTHALMOLOGY 3601 4TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794300001",
            "telephone_number": "806-743-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "MARK",
        "middle_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-23",
        "last_updated": "2026-04-12",
        "certification_date": "2026-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10080216",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "W4419",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.