Provider Demographics
NPI:1437359395
Name:BARRETT, BETHANY ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ANN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BETHANY
Other - Middle Name:ANN
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4166 AMERICAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-6025
Mailing Address - Country:US
Mailing Address - Phone:916-979-9217
Mailing Address - Fax:
Practice Address - Street 1:2615 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5904
Practice Address - Country:US
Practice Address - Phone:916-447-2020
Practice Address - Fax:916-447-2910
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA13236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06634Medicare UPIN