Provider Demographics
NPI:1528652831
Name:BERTKE, CHRISTOPHER JORDAN (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JORDAN
Last Name:BERTKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 DUDLEY PIKE
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3296
Mailing Address - Country:US
Mailing Address - Phone:859-341-0888
Mailing Address - Fax:
Practice Address - Street 1:581 DUDLEY PIKE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3296
Practice Address - Country:US
Practice Address - Phone:859-341-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2217DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist