Provider Demographics
NPI:1093908329
Name:BEATTY, ANDREA M (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:BEATTY
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 1:16202 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9535
Mailing Address - Country:US
Mailing Address - Phone:913-962-2010
Mailing Address - Fax:913-962-2013
Practice Address - Street 1:16202 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9535
Practice Address - Country:US
Practice Address - Phone:913-962-2010
Practice Address - Fax:913-962-2013
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1601152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30585025OtherBLUE CROSS BLUE SHIELD MO
KS30585025OtherBLUE CROSS BLUE SHIELD MO
KSL64B423Medicare PIN