Provider Demographics
NPI:1538214663
Name:MACHAMER, BERNICE (OD)
Entity type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:
Last Name:MACHAMER
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 1:31 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972
Mailing Address - Country:US
Mailing Address - Phone:570-385-1500
Mailing Address - Fax:570-385-5445
Practice Address - Street 1:31 PARKWAY
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972
Practice Address - Country:US
Practice Address - Phone:570-385-1500
Practice Address - Fax:570-385-5445
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA0E6000801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA288340Medicare ID - Type Unspecified
PAU08048Medicare UPIN
PA0896400001Medicare NSC