Provider Demographics
NPI:1205828357
Name:MINTON, BETH ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANNE
Last Name:MINTON
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 1:4000 POPLAR LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1524
Mailing Address - Country:US
Mailing Address - Phone:502-459-2020
Mailing Address - Fax:502-456-5925
Practice Address - Street 1:4000 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1524
Practice Address - Country:US
Practice Address - Phone:502-459-2020
Practice Address - Fax:502-456-5925
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYU92035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000350785OtherANTHEM BCBS
KY1551DTOtherOD LICENSE NUMBER
KYP00609333OtherRR MEDICARE
KY000000351953OtherANTHEM BCBS
KY77000636Medicaid
KY0941006Medicare ID - Type Unspecified
KY5419240010Medicare NSC
U92035Medicare UPIN