Healthcare Provider Details

I. General information

NPI: 1497750574
Provider Name (Legal Business Name): JONATHAN M BERNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 REGENCY CT STE 100
TOLEDO OH
43623-3081
US

IV. Provider business mailing address

850 W NORTH ST STE 104
JACKSON MI
49202-3196
US

V. Phone/Fax

Practice location:
  • Phone: 800-832-2015
  • Fax: 419-885-8440
Mailing address:
  • Phone: 877-852-8463
  • Fax: 517-817-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301061141
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number64990
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number4301061141
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number64990
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: