Provider Demographics
NPI:1245395292
Name:BESS, RAY D (OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:D
Last Name:BESS
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863
Mailing Address - Country:US
Mailing Address - Phone:573-276-3239
Mailing Address - Fax:573-276-3239
Practice Address - Street 1:107 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863
Practice Address - Country:US
Practice Address - Phone:573-276-3239
Practice Address - Fax:573-276-3239
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T42704Medicare UPIN
0577140001Medicare NSC