Beth Bazin, O.D.
Individual provider Active NPI Optometrist · Kansas City, MO
NPI 1154421402 · NPPES record last updated Aug 22, 2024
Key facts
- NPI
- 1154421402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2211 (KS)
- Practice address
- 1441 E 104TH St
BLDG. 3 - Suite 103
Kansas City, MO 64131-4634 - Phone
- (816) 333-1500
- Fax
- (816) 943-0885
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T03320 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bridge Hill Eye, LLC | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T03320 | MO | |
| Pediatric Optometrist | 152WP0200X | T03320 | MO | |
| Vision Therapy Optometrist | 152WV0400X | T03320 | MO | |
| Optometrist | 152W00000X | 2211 | KS | Yes |
Addresses
Primary practice location
1441 E 104TH St
BLDG. 3 - Suite 103
Kansas City, MO 64131-4634
Mailing address
7235 W 79 Street
Overland Park, KS 66204-3664
Phone (816) 333-1500
Other names
- Beth Bazin
Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.