Provider Demographics
NPI:1043394208
Name:BEATY, STEVE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:BEATY
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 1:1020 N GLOSTER ST STE 261
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1202
Mailing Address - Country:US
Mailing Address - Phone:662-269-4175
Mailing Address - Fax:662-269-4176
Practice Address - Street 1:837 KINGS CROSSING DR STE 10
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0952
Practice Address - Country:US
Practice Address - Phone:662-269-4175
Practice Address - Fax:662-269-4176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880181Medicaid
MS1282930001Medicare NSC
MS00880181Medicaid