Provider Demographics
NPI:1336319813
Name:DEBORAH S. BERNAY OD PC
Entity Type:Organization
Organization Name:DEBORAH S. BERNAY OD PC
Other - Org Name:LA PORTE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-471-6546
Mailing Address - Street 1:401 W FAIRMONT PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6307
Mailing Address - Country:US
Mailing Address - Phone:281-471-6546
Mailing Address - Fax:281-471-3411
Practice Address - Street 1:401 W FAIRMONT PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6307
Practice Address - Country:US
Practice Address - Phone:281-471-6546
Practice Address - Fax:281-471-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3011TG152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112415802Medicaid
TX112415802Medicaid
TX0901160001Medicare NSC