Provider Demographics
NPI:1285612770
Name:BERNTSEN, DAVID A (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BERNTSEN
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-2020
Mailing Address - Country:US
Mailing Address - Phone:713-743-2020
Mailing Address - Fax:713-743-0963
Practice Address - Street 1:4401 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-2020
Practice Address - Country:US
Practice Address - Phone:713-743-2020
Practice Address - Fax:713-743-0963
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5287152W00000X, 152WC0802X
TX06274T152W00000X
TX6274TG152W00000X
TX6274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281270301Medicaid
TX1124091-04Medicaid
TXTXB117913Medicare PIN
TX1124091-04Medicaid
TX00E63GMedicare UPIN