MEDICARE: DR. ANNA BEDROSSIAN 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	10674T	CA

General Provider Information

NPI Number	:	1609869395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA BEDROSSIAN O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1553
Second Line	:
City	:	BIG BEAR LAKE
State	:	CA
Zip	:	92315-1553
Country	:	US
Telephone Number	:	909-866-8002
Fax Number	:	909-866-8023

Provider Business Practice Location Address
First Line	:	42002 FOX FARM RD. #100
Second Line	:
City	:	BIG BEAR LAKE
State	:	CA
Zip	:	92315-1553
Country	:	US
Telephone Number	:	909-866-8002
Fax Number	:	909-866-8023

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/28/2008

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