Provider Demographics
NPI:1295984466
Name:BERNARDI, CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:BERNARDI
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 1:850 E GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4502
Mailing Address - Country:US
Mailing Address - Phone:847-519-1020
Mailing Address - Fax:847-519-0626
Practice Address - Street 1:850 E GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4502
Practice Address - Country:US
Practice Address - Phone:847-519-1020
Practice Address - Fax:847-519-0626
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03632Medicare PIN