Provider Demographics
NPI:1275500035
Name:BETHEL, AMIE R (OD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:R
Last Name:BETHEL
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 1:16303 YELLOW SAGE ST
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3529
Mailing Address - Country:US
Mailing Address - Phone:512-251-4099
Mailing Address - Fax:512-251-2941
Practice Address - Street 1:16303 YELLOW SAGE ST
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3529
Practice Address - Country:US
Practice Address - Phone:512-251-4099
Practice Address - Fax:512-251-2941
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05100TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1016917-01Medicaid
81146EMedicare ID - Type Unspecified
TXU56989Medicare UPIN
TX0895440001Medicare NSC
TX0895440002Medicare NSC