MEDICARE: DR. RUFUS BEDFORD ANTLEY O.D.

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	433	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0652760001	OTHER	SC	DMERC
2	570629655-002	OTHER	SC	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306835582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUFUS BEDFORD ANTLEY O.D.

Provider Business Mailing Address
First Line	:	117 W CHURCH ST
Second Line	:
City	:	BATESBURG
State	:	SC
Zip	:	29006-2108
Country	:	US
Telephone Number	:	803-532-9870
Fax Number	:	803-532-1259

Provider Business Practice Location Address
First Line	:	117 W CHURCH ST
Second Line	:
City	:	BATESBURG
State	:	SC
Zip	:	29006-2108
Country	:	US
Telephone Number	:	803-532-9870
Fax Number	:	803-532-1259

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	02/26/2008

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