MEDICARE: BETHANIE H DEEMER O.D.

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	AZ1300	AZ
2	152W00000X	Optometrist	12477T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588659213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANIE H DEEMER O.D.

Provider Business Mailing Address
First Line	:	8877 W UNION HILLS DR STE 460
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8003
Country	:	US
Telephone Number	:	623-256-0400
Fax Number	:	623-376-6800

Provider Business Practice Location Address
First Line	:	8877 W UNION HILLS DR STE 460
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8003
Country	:	US
Telephone Number	:	623-256-0400
Fax Number	:	623-376-6800

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	05/16/2013

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