Provider Demographics
NPI:1114010162
Name:BESCOBY, WILLIAM A (OD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:BESCOBY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 19TH ST
Mailing Address - Street 2:STE 356
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4608
Mailing Address - Country:US
Mailing Address - Phone:909-885-6193
Mailing Address - Fax:909-884-3015
Practice Address - Street 1:8780 19TH ST
Practice Address - Street 2:STE 356
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-4608
Practice Address - Country:US
Practice Address - Phone:909-885-6193
Practice Address - Fax:909-884-3015
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7132T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10478Medicare UPIN
CASDO071322Medicare ID - Type Unspecified