Provider Demographics
NPI:1093898835
Name:BEDFORD, ANNE K (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:K
Last Name:BEDFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N MONTESANO ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98595-9730
Mailing Address - Country:US
Mailing Address - Phone:360-268-1114
Mailing Address - Fax:360-268-1114
Practice Address - Street 1:723 N MONTESANO ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:WA
Practice Address - Zip Code:98595-9730
Practice Address - Country:US
Practice Address - Phone:360-268-1114
Practice Address - Fax:360-268-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2014280Medicaid
WA2014280Medicaid
WAG000800178Medicare PIN
WAT02624Medicare UPIN