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General NPI Number Information
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NPI Number | 1164823142
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Entity Type | Individual
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Provider Name | NICHOLAS E BEM OD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D.L. INGRAM AVENUE, BLDG. 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 575-904-3881
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Fax |
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Provider Business Mailing Address
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Address Line | 27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D.L. INGRAM AVENUE, BLDG. 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11106297-9934
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License Number State | UT
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