Provider Demographics
NPI:1578084182
Name:MAMPHEY, BERNARD (OD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:MAMPHEY
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 1:919 LAKELAND PARK CENTER DR UNIT 314
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3841
Mailing Address - Country:US
Mailing Address - Phone:863-859-6500
Mailing Address - Fax:
Practice Address - Street 1:3615 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4876
Practice Address - Country:US
Practice Address - Phone:863-859-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist