Provider Demographics
NPI:1356569214
Name:BEZVERKH, KLARA
Entity type:Individual
Prefix:
First Name:KLARA
Middle Name:
Last Name:BEZVERKH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 GEARY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3456
Mailing Address - Country:US
Mailing Address - Phone:415-921-3222
Mailing Address - Fax:415-921-3227
Practice Address - Street 1:2186 GEARY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3456
Practice Address - Country:US
Practice Address - Phone:415-921-3222
Practice Address - Fax:415-921-3227
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6728156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician