Provider Demographics
NPI:1861567117
Name:BERENTHAL, ALEX (OD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BERENTHAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5302
Mailing Address - Country:US
Mailing Address - Phone:305-661-2732
Mailing Address - Fax:305-669-3157
Practice Address - Street 1:5730 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5302
Practice Address - Country:US
Practice Address - Phone:305-661-2732
Practice Address - Fax:305-669-3157
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6210708Medicaid
FL6210708Medicaid
FLAC439Medicare PIN