Provider Demographics
NPI:1053425488
Name:BERGIDA, RICHARD WILLIAM (DO)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:BERGIDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 S FEDERAL HWY
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3329
Mailing Address - Country:US
Mailing Address - Phone:561-276-5099
Mailing Address - Fax:561-274-9697
Practice Address - Street 1:1715 S FEDERAL HWY
Practice Address - Street 2:SUITE C-1
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3329
Practice Address - Country:US
Practice Address - Phone:561-276-5099
Practice Address - Fax:561-274-9697
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 1387156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician