Provider Demographics
NPI:1447261037
Name:BESTWINA, BRAD A (OD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:BESTWINA
Suffix:
Gender:M
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:SUITE 201
Mailing Address - Street 2:299 CAREW ST
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-736-1833
Mailing Address - Fax:413-781-1899
Practice Address - Street 1:SUITE 201
Practice Address - Street 2:299 CAREW ST
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-736-1833
Practice Address - Fax:413-781-1899
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0700266Medicaid
V01103Medicare UPIN
MA0700266Medicaid