MEDICARE: DR. E. BEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2377	TX

General Provider Information

NPI Number	:	1265432249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. E. BEAN

Provider Business Mailing Address
First Line	:	PO BOX 1364
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-1364
Country	:	US
Telephone Number	:	817-282-8746
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 RIDGECREST DR
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-6554
Country	:	US
Telephone Number	:	817-282-8746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. E. BEAN ” Practice Location

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