Basic Information
| Provider Information | |||||||||
| NPI: | 1376541540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERDY | ||||||||
| FirstName: | GREGG | ||||||||
| MiddleName: | JONATHAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12990 MANCHESTER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631311860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149665000 | ||||||||
| FaxNumber: | 3149096666 | ||||||||
| Practice Location | |||||||||
| Address1: | 12990 MANCHESTER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631311860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149665000 | ||||||||
| FaxNumber: | 3149096666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | R1E17 | MO | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.