Healthcare Provider Details

I. General information

NPI: 1477703213
Provider Name (Legal Business Name): BERTRAM EYECARE, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 12/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 BUTTERMILK PIKE SUITE 100
CRESCENT SPRINGS KY
41017-1303
US

IV. Provider business mailing address

705 BUTTERMILK PIKE SUITE 100
CRESCENT SPRINGS KY
41017-1303
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-3937
  • Fax:
Mailing address:
  • Phone: 859-341-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: PAUL TIMOTHY BERTRAM
Title or Position: PRESIDENT
Credential: O.D.
Phone: 859-341-3937