Provider Demographics
NPI:1679690929
Name:BERRIS, WILLIAM A
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:BERRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3313
Mailing Address - Country:US
Mailing Address - Phone:216-381-1466
Mailing Address - Fax:
Practice Address - Street 1:2183 S GREEN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3313
Practice Address - Country:US
Practice Address - Phone:216-381-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH859 S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0430280001Medicaid
OH0430280001Medicaid
OH0430280001Medicare NSC