MEDICARE: DAVID L BEJOT OD

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	4439	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180016444	OTHER		RAILROAD MEDICARE

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
3	000000126980	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1588668222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L BEJOT OD

Provider Business Mailing Address
First Line	:	850 W NORTH ST
Second Line	:	SUITE 104
City	:	JACKSON
State	:	MI
Zip	:	49202-3196
Country	:	US
Telephone Number	:	877-852-8463
Fax Number	:	517-841-0144

Provider Business Practice Location Address
First Line	:	3000 REGENCY CT
Second Line	:	STE 100
City	:	TOLEDO
State	:	OH
Zip	:	43623-3081
Country	:	US
Telephone Number	:	419-882-2020
Fax Number	:	419-885-8440

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	04/13/2012

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Directions to “ DAVID L BEJOT OD” Practice Location

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