Provider Demographics
NPI:1871842674
Name:BERNHARDT VISION PC
Entity type:Organization
Organization Name:BERNHARDT VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-461-3464
Mailing Address - Street 1:102 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5523
Mailing Address - Country:US
Mailing Address - Phone:970-690-0822
Mailing Address - Fax:970-638-2155
Practice Address - Street 1:102 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5551
Practice Address - Country:US
Practice Address - Phone:970-461-3464
Practice Address - Fax:970-638-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2919302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization