Kevin C. Berg, O.D., LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

104 Issued in AK

Legal business name

KEVIN C. BERG, O.D., LLC

Practice address

1350 S Seward Meridian Pkwy
Wasilla, AK 99654-8332

Phone

(907) 376-0835

Fax

(907) 376-0843

NPI assigned

Feb 25, 2006

Last updated

Mar 11, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Craig Berg, O.D.

Title

Owner

Phone

(907) 376-0835

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1140825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1881660207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 S SEWARD MERIDIAN PKWY",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548332",
            "telephone_number": "907-376-0835",
            "fax_number": "907-376-0843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S SEWARD MERIDIAN PKWY",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548332",
            "telephone_number": "907-376-0835",
            "fax_number": "907-376-0843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN C. BERG, O.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-25",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-376-0835",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AK",
            "license": "104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OD1144",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Optometrist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.