NPIMap

Organization Active NPI

Berkeley Eye Institute, PLLC

Doing business as Berkeley Eye Center

  • Ophthalmology Physician
  • Lake Jackson, TX
National Provider Identifier
1982462644
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
BERKELEY EYE INSTITUTE, PLLC
Doing business as
Berkeley Eye Center
Practice address
117 Circle Way St
Lake Jackson, TX 77566-5233
Phone
(979) 297-4042
Fax
(979) 297-4686
NPI assigned
Mar 7, 2024
Last updated
Mar 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Mark Micheletti
Title
Executive Officer
Phone
(281) 348-4615

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

117 Circle Way St
Lake Jackson, TX 77566-5233

Mailing address

22741 Professional Dr
Kingwood, TX 77339-6005
Phone (281) 944-2232

Other names 1

  • Berkeley Eye Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240507002348 TX DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 4082602156 Practice locations: Lake Jackson, TX

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Berkeley Eye Center117 Circle Way St, Lake Jackson, TX 77566-5233(979) 297-4042 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jul 1, 2003

National Provider Directory

National Provider Directory
Tax ID family
Berkeley Eye Institute PLLC23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Member of 1

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

Locations

22741 Professional Dr
Kingwood, TX 77339
Phone (281) 319-4334

NPI Registry JSON

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1982462644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22741 PROFESSIONAL DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773396005",
            "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": "117 CIRCLE WAY ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665233",
            "telephone_number": "979-297-4042",
            "fax_number": "979-297-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERKELEY EYE INSTITUTE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "MICHELETTI",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "281-348-4615"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkeley Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Jackson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.