Provider Demographics
NPI:1437577749
Name:BEBAWY OPTOMETRY INC
Entity Type:Organization
Organization Name:BEBAWY OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:AZIZ KEROLLOS
Authorized Official - Last Name:BEBAWY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-235-1998
Mailing Address - Street 1:418 AUTO CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5458
Mailing Address - Country:US
Mailing Address - Phone:909-621-5400
Mailing Address - Fax:909-621-5411
Practice Address - Street 1:418 AUTO CENTER DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5458
Practice Address - Country:US
Practice Address - Phone:909-621-5400
Practice Address - Fax:909-621-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14579TPA302F00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No332H00000XSuppliersEyewear Supplier