Provider Demographics
NPI:1699868653
Name:BICKFORD, JODY R (OD)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:R
Last Name:BICKFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-0054
Mailing Address - Country:US
Mailing Address - Phone:530-223-6586
Mailing Address - Fax:530-241-1279
Practice Address - Street 1:2216 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3838
Practice Address - Country:US
Practice Address - Phone:530-241-6550
Practice Address - Fax:530-241-1279
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12047T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU75654Medicare UPIN
CASD0120470Medicare ID - Type Unspecified