Provider Demographics
NPI:1275738338
Name:ANNE K BEDFORD OD INC PS
Entity Type:Organization
Organization Name:ANNE K BEDFORD OD INC PS
Other - Org Name:SOUTH BEACH VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:BEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-268-1114
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVOD00001631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410018817OtherRAILROAD MEDICARE
WAG8891334Medicare PIN
WADS5002Medicare PIN
WA0642130001Medicare NSC