Provider Demographics
NPI:1114918802
Name:JUE SMITH, BEVERLY (OD, MS, MBA, CPNP)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:JUE SMITH
Suffix:
Gender:F
Credentials:OD, MS, MBA, CPNP
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 1973
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6973
Mailing Address - Country:US
Mailing Address - Phone:925-487-3747
Mailing Address - Fax:925-648-1127
Practice Address - Street 1:215 ALAMO PLZ STE D
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1531
Practice Address - Country:US
Practice Address - Phone:925-202-2846
Practice Address - Fax:925-648-1127
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2921T152W00000X
CA8094152W00000X
CA8094T152W00000X
CA8094TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13527Medicare UPIN