Provider Demographics
NPI:1972624658
Name:HALE, BERNARD JOHN (O D)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:JOHN
Last Name:HALE
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 ROSECREST DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2039
Mailing Address - Country:US
Mailing Address - Phone:510-206-2376
Mailing Address - Fax:
Practice Address - Street 1:1773 SAN PABLO AVE
Practice Address - Street 2:SUITE #A1
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2013
Practice Address - Country:US
Practice Address - Phone:510-724-6520
Practice Address - Fax:510-724-7094
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11052T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA55476Medicare UPIN