Provider Demographics
NPI:1326020637
Name:SPEARMAN, BEVERLY K (OD PC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:K
Last Name:SPEARMAN
Suffix:
Gender:F
Credentials:OD PC
Other - Prefix:DR
Other - First Name:BEVERLY
Other - Middle Name:ROBERTSON
Other - Last Name:SEPARMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:183 COUNTY ROAD 4171
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-4133
Mailing Address - Country:US
Mailing Address - Phone:903-856-2650
Mailing Address - Fax:
Practice Address - Street 1:135 QUITMAN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1359
Practice Address - Country:US
Practice Address - Phone:903-856-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2804TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1123341-01Medicaid
TX00E17AMedicare ID - Type UnspecifiedMEDICARE
TX0151820001Medicare ID - Type UnspecifiedPALMETTO MEDICARE
TX410001325Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX1123341-01Medicaid