Healthcare Provider Details

I. General information

NPI: 1588668222
Provider Name (Legal Business Name): DAVID L BEJOT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 REGENCY CT STE 100
TOLEDO OH
43623-3081
US

IV. Provider business mailing address

850 W NORTH ST SUITE 104
JACKSON MI
49202-3196
US

V. Phone/Fax

Practice location:
  • Phone: 419-882-2020
  • Fax: 419-885-8440
Mailing address:
  • Phone: 877-852-8463
  • Fax: 517-841-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4439
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: