MEDICARE: MATTHEW BEDELL MD INC.

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	207W00000X	Ophthalmology Physician	A124311	CA

General Provider Information

NPI Number	:	1164961934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW BEDELL MD INC.

Provider Business Mailing Address
First Line	:	950 NORTHGATE DR STE 209
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-3433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 NORTHGATE DR STE 209
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-3433
Country	:	US
Telephone Number	:	415-461-5500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MATTHEW BEDELL
Credential	:
Telephone Number	:	858-342-2781

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	02/14/2017

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