Provider Demographics
NPI:1265631139
Name:BEATY, MELISSA A (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:BEATY
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 1:9011 W. SAHARA AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4801
Mailing Address - Country:US
Mailing Address - Phone:702-792-3937
Mailing Address - Fax:702-732-4108
Practice Address - Street 1:9011 W SAHARA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4800
Practice Address - Country:US
Practice Address - Phone:702-792-3937
Practice Address - Fax:702-732-4108
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist