NPIMap

Berkeley Eye Institute, PLLC

Organization Active NPI Ophthalmology Physician · Brenham, TX

NPI 1770950784 · NPPES record last updated Mar 31, 2023

Key facts

NPI
1770950784
Entity type
Organization (NPI type 2)
Primary specialty
Ophthalmology Physician 207W00000X
Legal business name
BERKELEY EYE INSTITUTE, PLLC
Practice address
605 Medical CT Ste 203
Brenham, TX 77833
Phone
(979) 830-1444
Fax
(979) 830-1866
NPI assigned
Aug 25, 2015
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 19

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

Corporate family (same tax ID) 22

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

Member of 1

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 62

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

View all 62

Laboratory certificates & supplier records

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Berkeley Eye Center
605 Medical CT, Brenham, TX 77833-5406 · (979) 830-1444		 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignment
Participating since Jul 1, 2003

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20220913000331 TX DME Supplier - Physician - Ophthalmology
DME Supplier - Physician - Optometrist		 4082602156 Practice locations: Brenham, TX

National Provider Directory

Tax ID family
Berkeley Eye Institute PA (23 organizations share this tax ID)

Locations

605 Medical Ct
Ste 205
Brenham, TX 77833

635 Medical Pkwy
Brenham, TX 77833
Phone (979) 830-1444

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X
Ophthalmology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207W00000X Yes
Eyewear Supplier 332H00000X

Addresses

Primary practice location

605 Medical CT Ste 203
Brenham, TX 77833

Mailing address

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

Other names

  • Berkeley Eye Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 31, 2023.

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680220800000",
    "number": "1770950784",
    "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": "605 MEDICAL CT STE 203",
            "city": "BRENHAM",
            "state": "TX",
            "postal_code": "77833",
            "telephone_number": "979-830-1444",
            "fax_number": "979-830-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERKELEY EYE INSTITUTE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "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": [],
    "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 Brenham, TX

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Sources for this page

Verify at the official NPI Registry.