Provider Demographics
NPI:1194744599
Name:BERNER, KAY ELAINE (OD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:ELAINE
Last Name:BERNER
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 1:329 SUNBURY ST
Mailing Address - Street 2:P.O. BOX 643
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1239
Mailing Address - Country:US
Mailing Address - Phone:570-544-4792
Mailing Address - Fax:570-544-3509
Practice Address - Street 1:329 SUNBURY ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1239
Practice Address - Country:US
Practice Address - Phone:570-544-4792
Practice Address - Fax:570-544-3509
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008924270001Medicaid
PA50003484OtherBLUE CROSS
PA397406OtherNVA
PABE198348OtherBLUE SHIELD
PABE198348Medicare PIN