Provider Demographics
NPI:1356321525
Name:ESPOSITO, BETH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:ELSON-ESPOSITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7402 SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7808
Mailing Address - Country:US
Mailing Address - Phone:304-363-2929
Mailing Address - Fax:304-363-6652
Practice Address - Street 1:2356 MEADOWBROOK MALL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9790
Practice Address - Country:US
Practice Address - Phone:304-842-3523
Practice Address - Fax:304-842-7337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV933-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist