Provider Demographics
NPI:1861595027
Name:BERNS, LEORA A (OD)
Entity type:Individual
Prefix:DR
First Name:LEORA
Middle Name:A
Last Name:BERNS
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 1:43 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-676-2376
Mailing Address - Fax:860-677-0517
Practice Address - Street 1:43 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-676-2376
Practice Address - Fax:860-677-0517
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090002118CT04OtherANTHEM
T22330OtherVSP
CT1015675OtherAETNA
757076OtherCONNECTICARE
P2542157OtherOXFORD
CT090002118CT04OtherANTHEM