Provider Demographics
NPI:1508159344
Name:BEDELL, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BEDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S ELISEO DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-925-2020
Practice Address - Fax:415-925-1870
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124311207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology