Provider Demographics
NPI:1942229943
Name:BEZAN, DEBRA JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JEAN
Last Name:BEZAN
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 1:8829 S KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3000
Mailing Address - Country:US
Mailing Address - Phone:918-494-0166
Mailing Address - Fax:
Practice Address - Street 1:8829 S KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3000
Practice Address - Country:US
Practice Address - Phone:918-494-0166
Practice Address - Fax:918-494-0166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1174230001OtherMEDICARE - DMERC