Provider Demographics
NPI:1588659213
Name:DEEMER, BETHANIE H (OD)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:H
Last Name:DEEMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8877 W UNION HILLS DR STE 460
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8003
Mailing Address - Country:US
Mailing Address - Phone:623-256-0400
Mailing Address - Fax:623-376-6800
Practice Address - Street 1:8877 W UNION HILLS DR STE 460
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8003
Practice Address - Country:US
Practice Address - Phone:623-256-0400
Practice Address - Fax:623-376-6800
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1300152W00000X
CA12477T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084323Medicaid
AZ084323Medicaid
AZZ105875Medicare PIN