Healthcare Provider Details

I. General information

NPI: 1790595171
Provider Name (Legal Business Name): NICHOLAS BERNHARDT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 TOWN CENTER PL STE 5
COLUMBIA SC
29229-7957
US

IV. Provider business mailing address

470 TOWN CENTER PL STE 5
COLUMBIA SC
29229-7957
US

V. Phone/Fax

Practice location:
  • Phone: 803-636-2016
  • Fax: 803-636-2016
Mailing address:
  • Phone: 803-636-2016
  • Fax: 803-636-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2529
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007348
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: