Healthcare Provider Details

I. General information

NPI: 1053303859
Provider Name (Legal Business Name): PATRICIA A BEQUETTE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA A. BLUME O.D

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MID RIVERS MALL
SAINT PETERS MO
63376-4360
US

IV. Provider business mailing address

1337 SUNNY TRAIL CT
O FALLON MO
63366-3433
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-1222
  • Fax: 636-278-1688
Mailing address:
  • Phone: 636-294-4683
  • Fax: 636-278-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02685
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: