Provider Demographics
NPI:1053303859
Name:BEQUETTE, PATRICIA A (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:BEQUETTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:BLUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1337 SUNNY TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3433
Mailing Address - Country:US
Mailing Address - Phone:636-294-4683
Mailing Address - Fax:636-278-1688
Practice Address - Street 1:1600 MID RIVERS MALL
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-4360
Practice Address - Country:US
Practice Address - Phone:636-397-1222
Practice Address - Fax:636-278-1688
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1092502Medicaid
IA410038836OtherRAILROAD MEDICARE
IA1092502Medicaid
IA48185Medicare PIN
MO1092502Medicaid
MO48185Medicare PIN
IA410038836OtherRAILROAD MEDICARE
MOU;37947Medicare UPIN