Provider Demographics
NPI:1578875134
Name:DONALDSON, BERNADINE MARIE (O D)
Entity Type:Individual
Prefix:DR
First Name:BERNADINE
Middle Name:MARIE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:O D
Other - Prefix:MS
Other - First Name:BERNADINE
Other - Middle Name:MARIE
Other - Last Name:KALENKOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 MUSGROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2350
Mailing Address - Country:US
Mailing Address - Phone:864-833-5555
Mailing Address - Fax:864-833-5520
Practice Address - Street 1:118 MUSGROVE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2350
Practice Address - Country:US
Practice Address - Phone:864-833-5555
Practice Address - Fax:864-833-5520
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC271803882OtherTAX ID
SC753176906OtherMEDICARE ID
SC8525Medicare PIN
SC5595510001Medicare NSC
SC753176906OtherMEDICARE ID