Provider Demographics
NPI:1467494302
Name:BEATTIE, SHARON C (OD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:C
Last Name:BEATTIE
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 1:200 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5675
Mailing Address - Country:US
Mailing Address - Phone:701-222-3937
Mailing Address - Fax:701-222-8805
Practice Address - Street 1:200 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5675
Practice Address - Country:US
Practice Address - Phone:701-222-3937
Practice Address - Fax:701-222-8805
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455086Medicaid
410018231OtherRAILROAD MEDICARE ID
MT484263Medicaid
22-03331OtherMEDICA
488241044245OtherPREFERRED ONE
23404OtherSIOUX VALLEY HEALTH PLAN
ND60295Medicaid
ND200OtherVISION BENEFIT OF AMERICA
ND0409OtherEYEMED
800409OtherNDVSI
SD9202650Medicaid
61503OtherCOAST TO COAST
ND312OtherBCBS
ND200OtherVISION BENEFIT OF AMERICA