Provider Demographics
NPI:1598790438
Name:BERNSTEIN, HARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:A
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124
Mailing Address - Country:US
Mailing Address - Phone:847-836-1122
Mailing Address - Fax:847-836-1121
Practice Address - Street 1:2521 TECHNOLOGY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124
Practice Address - Country:US
Practice Address - Phone:847-836-1122
Practice Address - Fax:847-836-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2020-0822207W00000X
IL036072606207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072606Medicaid
ILK29803Medicare PIN
ILE18694Medicare UPIN
IL0746970001Medicare NSC