Provider Demographics
NPI:1750384194
Name:BERNARD, PAMELA (OD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 LOVELAND MADEIRA RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8965
Mailing Address - Country:US
Mailing Address - Phone:513-683-8900
Mailing Address - Fax:513-683-8910
Practice Address - Street 1:10661 LOVELAND MADEIRA RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8965
Practice Address - Country:US
Practice Address - Phone:513-683-8900
Practice Address - Fax:513-683-8910
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4544/T1287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4544OtherHUMANA
OH000000018959OtherBLUE CROSS/BLUE SHIELD
OH311415136OtherAETNA
OH22-00825OtherUNITED HEALTH CARE
OH4544OtherHUMANA
OHU52689Medicare UPIN