Provider Demographics
NPI:1609920701
Name:BERK, ANNE ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELIZABETH
Last Name:BERK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13180 SE 169TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8727
Mailing Address - Country:US
Mailing Address - Phone:503-698-2375
Mailing Address - Fax:503-698-3398
Practice Address - Street 1:13180 SE 169TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-8727
Practice Address - Country:US
Practice Address - Phone:503-698-2375
Practice Address - Fax:503-698-3398
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1749ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1749ATIOtherOD LICENSE NUMBER
OR120345Medicaid
1508037607OtherORGANIZATIONAL (GROUP) NPI
R0000WDBCWOtherMEDICARE GROUP PIN
1508037607OtherORGANIZATIONAL (GROUP) NPI
ORT89720Medicare UPIN