Provider Demographics
NPI:1689662256
Name:BEBBER, O JOSEPH JR (OD)
Entity Type:Individual
Prefix:DR
First Name:O
Middle Name:JOSEPH
Last Name:BEBBER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:608 GARRISON ST
Mailing Address - Street 2:UNIT E
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5881
Mailing Address - Country:US
Mailing Address - Phone:303-232-0200
Mailing Address - Fax:303-232-4044
Practice Address - Street 1:608 GARRISON ST
Practice Address - Street 2:UNIT E
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5881
Practice Address - Country:US
Practice Address - Phone:303-232-0200
Practice Address - Fax:303-232-4044
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO829152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04765335Medicaid
CO04765335Medicaid
COCO41028Medicare PIN