Provider Demographics
NPI:1437197191
Name:BEATTIE, BRIAN C (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 N WASHINGTON ST STE AA
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1616
Mailing Address - Country:US
Mailing Address - Phone:701-255-7894
Mailing Address - Fax:701-989-6098
Practice Address - Street 1:1929 N WASHINGTON ST STE AA
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1616
Practice Address - Country:US
Practice Address - Phone:701-255-7894
Practice Address - Fax:701-989-6098
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463219Medicaid
SD9201560Medicaid
ND300OtherBCBS - MAIN CLINIC
22-03327OtherMEDICA - NORTH CLINIC
410018229OtherRAILROAD MEDICARE ID
488241044244OtherPREFERRED ONE
ND0391OtherEYEMED
23403OtherSIOUX VALLEY HEALTH PLAN
22-03328OtherMEDICA - MAIN CLINIC
800391OtherNDVSI - MAIN CLINIC
892875OtherNDVSI - NORTH CLINIC
ND200OtherVISION BENEFIT OF AMERICA
MT484263Medicaid
ND60279Medicaid
61503OtherCOAST TO COAST
410018229OtherRAILROAD MEDICARE ID
T66846Medicare UPIN