Provider Demographics
NPI:1528041860
Name:BEDNAR, MATTHEW J (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:BEDNAR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 NW PRAIRIE VIEW RD., STE.A
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079
Mailing Address - Country:US
Mailing Address - Phone:816-858-2522
Mailing Address - Fax:816-858-2946
Practice Address - Street 1:2441 NW PRAIRIE VIEW RD STE A
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7608
Practice Address - Country:US
Practice Address - Phone:816-858-2522
Practice Address - Fax:816-858-2946
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318693827Medicaid
MOU55449Medicare UPIN
MOL807658Medicare PIN