Provider Demographics
NPI:1669454732
Name:BERNSTEIN, ALAN JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JEFFREY
Last Name:BERNSTEIN
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 1:8122 120TH PL SE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4412
Mailing Address - Country:US
Mailing Address - Phone:425-227-7070
Mailing Address - Fax:425-687-9901
Practice Address - Street 1:8122 120TH PL SE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-4412
Practice Address - Country:US
Practice Address - Phone:425-227-7070
Practice Address - Fax:425-687-9901
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1116152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8889820OtherMEDICARE PTAN
WA000100442Medicare ID - Type Unspecified