Gina Berg
Individual provider Active NPI Optometrist · Chicago Ridge, IL
NPI 1710548151 · NPPES record last updated Jun 26, 2019
Key facts
- NPI
- 1710548151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046011321 (IL)
- Practice address
- 320 Chicago Ridge Mall
Chicago Ridge, IL 60415-2602 - Phone
- (708) 423-0033
- NPI assigned
- Jun 26, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046011321 | IL | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046011321 | IL | Yes |
Addresses
Primary practice location
320 Chicago Ridge Mall
Chicago Ridge, IL 60415-2602
Mailing address
662 W Roscoe St Apt 2
Chicago, IL 60657-2912
Other providers in Chicago Ridge, IL
- Hisham Atallah
- Liliana Lupita Avitia
- Juanbosco Ayala
- Courtney Bandemer
- Robin Louise Bauman
- Aaron D Berger
- Paul Robert Boone
- Reilly Bootle
- Christine D Boyd
- Kristin Bragiel
All providers in Chicago Ridge, IL · Optometrist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.