Provider Demographics
NPI:1225367733
Name:BETH DIGBY ANDERSON, O.D., PLLC
Entity Type:Organization
Organization Name:BETH DIGBY ANDERSON, O.D., PLLC
Other - Org Name:WYLIE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:DIGBY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-429-9090
Mailing Address - Street 1:130 N BALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4467
Mailing Address - Country:US
Mailing Address - Phone:972-429-9090
Mailing Address - Fax:972-429-7676
Practice Address - Street 1:130 N BALLARD AVE
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4467
Practice Address - Country:US
Practice Address - Phone:972-429-9090
Practice Address - Fax:972-429-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07085TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB10000Medicare UPIN
TXDQ6602Medicare PIN
TX0A6088Medicare PIN