Provider Demographics
NPI:1043373939
Name:BHAR, NINA D (OD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:D
Last Name:BHAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:388 S. WEBER RD.
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446
Mailing Address - Country:US
Mailing Address - Phone:815-609-6300
Mailing Address - Fax:815-609-6330
Practice Address - Street 1:388 S. WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446
Practice Address - Country:US
Practice Address - Phone:815-609-6300
Practice Address - Fax:815-609-6330
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-008591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008591Medicaid
IL046008591Medicare UPIN