Provider Demographics
NPI:1235155292
Name:ARNOLD, BERNARD (OD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 BARE RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9183
Mailing Address - Country:US
Mailing Address - Phone:843-795-7971
Mailing Address - Fax:843-795-6689
Practice Address - Street 1:7685 NORTHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4002
Practice Address - Country:US
Practice Address - Phone:843-795-7971
Practice Address - Fax:843-795-6689
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-00501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05019Medicaid
SC580002170OtherRR MEDICARE
SCT243870281Medicare PIN
SC0612890001Medicare NSC
T24387Medicare UPIN