Provider Demographics
NPI:1033187117
Name:BEATY, ELIZABETH JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JAMES
Last Name:BEATY
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 1:208 BROAD ST
Mailing Address - Street 2:P.O. BOX 329
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-4064
Mailing Address - Country:US
Mailing Address - Phone:843-479-3331
Mailing Address - Fax:843-479-3355
Practice Address - Street 1:208 BROAD ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-4064
Practice Address - Country:US
Practice Address - Phone:843-479-3331
Practice Address - Fax:843-479-3355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12243Medicaid
SCD12243Medicaid