MEDICARE: ANJLI J BEDI 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	3399-35	WI

General Provider Information

NPI Number	:	1417322777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJLI J BEDI O.D.

Provider Business Mailing Address
First Line	:	12000 W CARMEN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-2116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 E. OKLAHOMA AVE
Second Line	:	SUITE B
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2922
Country	:	US
Telephone Number	:	414-747-9977
Fax Number	:	414-747-9988

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

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	12/11/2015

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