MEDICARE: DR. PAMELA BERNARD O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4544/T1287	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4544	OTHER	OH	HUMANA
2	000000018959	OTHER	OH	BLUE CROSS/BLUE SHIELD
3	311415136	OTHER	OH	AETNA
4	22-00825	OTHER	OH	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1750384194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA BERNARD O.D.

Provider Business Mailing Address
First Line	:	10661 LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8965
Country	:	US
Telephone Number	:	513-683-8900
Fax Number	:	513-683-8910

Provider Business Practice Location Address
First Line	:	10661 LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8965
Country	:	US
Telephone Number	:	513-683-8900
Fax Number	:	513-683-8910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/19/2012

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Directions to “ DR. PAMELA BERNARD O.D.” Practice Location

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