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General NPI Number Information
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NPI Number | 1871842674
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Entity Type | Organization
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Legal Business Name | BERNHARDT VISION PC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 102 W 4TH ST
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City | LOVELAND
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State | CO
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Zip | 80537-5551
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Country | US
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Telephone | 970-461-3464
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Fax | 970-638-2155
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Provider Business Mailing Address
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Address Line | 102 W 4TH ST
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City | LOVELAND
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State | CO
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Zip | 80537-5523
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Country | US
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Telephone | 970-690-0822
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Fax | 970-638-2155
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. COREY BERNHARDT
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Credential | OD
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Telephone | 970-461-3464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 2919
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License Number State | CO
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