Provider Demographics
NPI:1366544363
Name:BEKHTEL, IRENA (OD)
Entity type:Individual
Prefix:DR
First Name:IRENA
Middle Name:
Last Name:BEKHTEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:IRENA
Other - Middle Name:
Other - Last Name:BEKHTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4915 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5707
Mailing Address - Country:US
Mailing Address - Phone:209-956-3323
Mailing Address - Fax:
Practice Address - Street 1:4762 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-1915
Practice Address - Country:US
Practice Address - Phone:209-594-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4104152W00000X
CA12748152W00000X
FLOPC3279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA410376OtherTUFTS
MAE314OtherHPHC
MA9607387-004OtherCIGNA
MA0313807Medicaid
MA10578OtherDAVIS
CA1274OtherEYEMED
MAW16212OtherBCBS
MA0019950OtherNHP
CASD0127481Medicare ID - Type UnspecifiedMEDICARE
MA0019950OtherNHP