Healthcare Provider Details

I. General information

NPI: 1245388933
Provider Name (Legal Business Name): BAZIN OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 E 104TH ST SUITE 103
KANSAS CITY MO
64131-4634
US

IV. Provider business mailing address

1441 E 104TH ST SUITE 103
KANSAS CITY MO
64131-4634
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-1500
  • Fax: 816-943-0885
Mailing address:
  • Phone: 816-333-1500
  • Fax: 816-943-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03320
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberT03320
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberT03320
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberT03220
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberT03320
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberT03320
License Number StateMO

VIII. Authorized Official

Name: DR. M. BETH BAZIN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 816-333-1500