Nicholas E Bem, OD
Individual provider Active NPI Optometrist · Cannon Afb, NM
NPI 1164823142 · NPPES record last updated Mar 26, 2024
Key facts
- NPI
- 1164823142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 11106297-9934 (UT)
- Practice address
- 27TH Special Operations Medical Group
224 W D.L. Ingram Avenue, BLDG. 1408
Cannon Afb, NM 88103 - Phone
- (575) 904-3881
- NPI assigned
- Sep 10, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141105002285 | NC | Practitioner - Optometry | 1951523018 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2376 | NC | MD | Professional Counselor |
| 11106297-9934 | UT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyecarecenter OD PA | Optometrist | Current |
Accepting new patients |
| Eyecarecenter OD PA | Optometrist | Current | Accepting new patients |
| Eyecarecenter, O.D., P.a. | Optometrist | Current |
Accepting new patients |
| Albemarle Eye Center, PLLC | Optometrist | Past | Accepting new patients |
Locations
1813 W Ehringhaus St
Elizabeth Cty, NC 27909
Phone (252) 333-1155
819 Tiffany Blvd
Rocky Mount, NC 27804
Phone (252) 972-2020
800 S Stratford Rd
Winston Salem, NC 27103
Phone (336) 765-5788
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11106297-9934 | UT | Yes |
Addresses
Primary practice location
27TH Special Operations Medical Group
224 W D.L. Ingram Avenue, BLDG. 1408
Cannon Afb, NM 88103
Mailing address
27TH Special Operations Medical Group
224 W D.L. Ingram Avenue, BLDG. 1408
Cannon Afb, NM 88103
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11106297-9934 | Other | UT | STATE OF UTAH DEPARTMENT OF COMMERCE |
| 2376 | Other | NC | NC BOARD OF OPTOMETRY |
Other providers in Cannon Afb, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.