Healthcare Provider Details

I. General information

NPI: 1528041860
Provider Name (Legal Business Name): MATTHEW J BEDNAR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 NW PRAIRIE VIEW RD STE A
PLATTE CITY MO
64079-7608
US

IV. Provider business mailing address

2441 NW PRAIRIE VIEW RD., STE.A
PLATTE CITY MO
64079
US

V. Phone/Fax

Practice location:
  • Phone: 816-858-2522
  • Fax: 816-858-2946
Mailing address:
  • Phone: 816-858-2522
  • Fax: 816-858-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03186
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: