Bernard James Haidler, O.D.
Individual provider Active NPI Optometrist · Colma, CA
NPI 1124179833 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124179833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT5863 (CA)
- Practice address
- 53 Colma Blvd
Ste F2 280 Metro Center
Colma, CA 94014-3231 - Phone
- (650) 992-2700
- Fax
- (650) 992-3215
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5863 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| OPT5863 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Denny Eye and Laser Center | Past | Accepting new patients | |
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | Accepting new patients | |
| Luxottica of America Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT5863 | CA | Yes |
Addresses
Primary practice location
53 Colma Blvd
Ste F2 280 Metro Center
Colma, CA 94014-3231
Mailing address
17 Coronet Ave
Mill Valley, CA 94941-1164
Phone (415) 388-6505
Other providers in Colma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.