Provider Demographics
NPI:1154421402
Name:BAZIN, BETH (OD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:BAZIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BAZIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:7235 W 79 STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3664
Mailing Address - Country:US
Mailing Address - Phone:816-333-1500
Mailing Address - Fax:816-817-3769
Practice Address - Street 1:1441 E 104TH ST
Practice Address - Street 2:BLDG. 3 - SUITE 103
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4634
Practice Address - Country:US
Practice Address - Phone:816-333-1500
Practice Address - Fax:816-943-0885
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03320152W00000X, 152WP0200X, 152WV0400X, 152WS0006X, 152WV0400X, 152WX0102X
KS2211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision