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General NPI Number Information
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NPI Number | 1255567178
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Entity Type | Organization
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Legal Business Name | BETHANY J. MCKITTRICK, OD, PC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 1325 DENVER AVE
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City | LOVELAND
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State | CO
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Zip | 80537-5120
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Country | US
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Telephone | 970-663-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 15065 IOLA ST
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City | BRIGHTON
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State | CO
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Zip | 80602-7453
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Country | US
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Telephone | 970-663-3937
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. BETHANY MCKITTRICK
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Credential | OD
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Telephone | 970-663-3937
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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 | 2425
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License Number State | CO
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