Provider Demographics
NPI:1710973318
Name:BERNSTEIN, RANDALL S (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
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 1:2710 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2958
Mailing Address - Country:US
Mailing Address - Phone:317-257-4444
Mailing Address - Fax:317-479-3105
Practice Address - Street 1:2710 E 62ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2958
Practice Address - Country:US
Practice Address - Phone:317-257-4444
Practice Address - Fax:317-479-3105
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001716B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT69235Medicare UPIN