Provider Demographics
NPI:1851544969
Name:ALTMANN, BERNARD C II (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:C
Last Name:ALTMANN
Suffix:II
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NAZARETH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2719
Mailing Address - Country:US
Mailing Address - Phone:610-253-0351
Mailing Address - Fax:
Practice Address - Street 1:2800 NAZARETH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2719
Practice Address - Country:US
Practice Address - Phone:610-253-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000000892156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102293990001Medicaid
PA102293990001Medicaid