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NPI Code Detail

MEDICARE: BETHANY EYE CENTER, LLC

MEDICARE: BETHANY EYE CENTER, LLC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1245278753
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHANY EYE CENTER, LLC
Provider Business Mailing Address
First Line : 2707 MILLER ST
Second Line :
City : BETHANY
State : MO
Zip : 64424-2704
Country : US
Telephone Number : 660-425-8116
Fax Number :
Provider Business Practice Location Address
First Line : 2707 MILLER ST
Second Line :
City : BETHANY
State : MO
Zip : 64424-2704
Country : US
Telephone Number : 660-425-8116
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ANTHONY JOSEPH VERACHTERT
Credential : O.D.
Telephone Number : 660-425-8116
Provider Enumeration Date : 06/04/2006
Last Update Date : 12/18/2007

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Directions to “BETHANY EYE CENTER, LLC ” Practice Location

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