Provider Demographics
NPI:1750302105
Name:HARRY A. BERNSTEIN M.D., LTD.
Entity Type:Organization
Organization Name:HARRY A. BERNSTEIN M.D., LTD.
Other - Org Name:ELGIN EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-836-1122
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072606207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072606Medicaid
IL0746970001Medicare NSC
IL036072606Medicaid
IL213975Medicare PIN