Provider Demographics
NPI:1154509396
Name:BEARDSLEY, KING S (OD)
Entity Type:Individual
Prefix:
First Name:KING
Middle Name:S
Last Name:BEARDSLEY
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 1:317 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4801
Mailing Address - Country:US
Mailing Address - Phone:956-686-7435
Mailing Address - Fax:956-686-6956
Practice Address - Street 1:317 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4801
Practice Address - Country:US
Practice Address - Phone:956-686-7435
Practice Address - Fax:956-686-6956
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist