Provider Demographics
NPI:1972788750
Name:MARES, BERNARD OSCAR
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:OSCAR
Last Name:MARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3844 N 32ND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4928
Mailing Address - Country:US
Mailing Address - Phone:602-522-8507
Mailing Address - Fax:602-522-8507
Practice Address - Street 1:3844 N 32ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4928
Practice Address - Country:US
Practice Address - Phone:602-522-8507
Practice Address - Fax:602-522-8507
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-30
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ367749OtherAHCCCS
AZ1166190001Medicare NSC