Provider Demographics
NPI:1831768548
Name:BERTKE, MEGAN CECILIA (OD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CECILIA
Last Name:BERTKE
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 1:7733 GALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT LORAMIE
Mailing Address - State:OH
Mailing Address - Zip Code:45845-9741
Mailing Address - Country:US
Mailing Address - Phone:937-467-9525
Mailing Address - Fax:
Practice Address - Street 1:21 N MIAMI ST
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1831
Practice Address - Country:US
Practice Address - Phone:937-698-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist