MEDICARE: DR. IRENA BEKHTEL 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	4104	MA
2	152W00000X	Optometrist	12748	CA
3	152W00000X	Optometrist	OPC3279	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410376	OTHER	MA	TUFTS
2	E314	OTHER	MA	HPHC
3	9607387-004	OTHER	MA	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	10578	OTHER	MA	DAVIS
6	1274	OTHER	CA	EYEMED
7	W16212	OTHER	MA	BCBS
8	0019950	OTHER	MA	NHP

General Provider Information

NPI Number	:	1366544363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENA BEKHTEL OD

Provider Business Mailing Address
First Line	:	4915 CLAREMONT AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-5707
Country	:	US
Telephone Number	:	209-956-3323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4762 SAINT ANDREWS DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1915
Country	:	US
Telephone Number	:	209-594-0554
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	10/30/2012

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