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General NPI Number Information
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NPI Number | 1124179833
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Entity Type | Individual
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Provider Name | BERNARD JAMES HAIDLER O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 53 COLMA BLVD STE F2 280 METRO CENTER
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City | COLMA
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State | CA
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Zip | 94014-3231
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Country | US
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Telephone | 650-992-2700
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Fax | 650-992-3215
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Provider Business Mailing Address
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Address Line | 17 CORONET AVE
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City | MILL VALLEY
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State | CA
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Zip | 94941-1164
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Country | US
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Telephone | 415-388-6505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT5863
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License Number State | CA
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