Provider Demographics
NPI:1346401502
Name:BERNARDO BEHRENS OD PLLC
Entity Type:Organization
Organization Name:BERNARDO BEHRENS OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-222-1200
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3556
Mailing Address - Country:US
Mailing Address - Phone:214-222-1200
Mailing Address - Fax:214-222-1202
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3556
Practice Address - Country:US
Practice Address - Phone:214-222-1200
Practice Address - Fax:214-222-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170420701Medicaid