Provider Demographics
NPI:1427080191
Name:BAHTIARIAN, FLORENCE BEJIAN (OD)
Entity type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:BEJIAN
Last Name:BAHTIARIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:FLORENCE
Other - Middle Name:
Other - Last Name:BEJIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:155 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1507
Mailing Address - Country:US
Mailing Address - Phone:978-250-3937
Mailing Address - Fax:978-256-1264
Practice Address - Street 1:17 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2712
Practice Address - Country:US
Practice Address - Phone:978-250-3937
Practice Address - Fax:978-256-1264
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300250Medicaid
MA460858Medicare PIN