Provider Demographics
NPI:1639136120
Name:BETHKA, STEVEN J (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:BETHKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 NORTH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3259
Mailing Address - Country:US
Mailing Address - Phone:970-245-7850
Mailing Address - Fax:970-242-0281
Practice Address - Street 1:950 NORTH AVE STE 106
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3259
Practice Address - Country:US
Practice Address - Phone:970-245-7850
Practice Address - Fax:970-242-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08013948Medicaid
COP00323440OtherRAILROAD MEDICARE
COC802008Medicare PIN
COP00323440OtherRAILROAD MEDICARE
CO08013948Medicaid