MEDICARE: DR. PATRICIA A BEQUETTE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T02685	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410038836	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053303859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA A BEQUETTE OD

Provider Business Mailing Address
First Line	:	1337 SUNNY TRAIL CT
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-3433
Country	:	US
Telephone Number	:	636-294-4683
Fax Number	:	636-278-1688

Provider Business Practice Location Address
First Line	:	1600 MID RIVERS MALL
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-4360
Country	:	US
Telephone Number	:	636-397-1222
Fax Number	:	636-278-1688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	04/05/2010

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