Provider Demographics
NPI:1558555953
Name:ANDERSON, BETH DIGBY (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:DIGBY
Last Name:ANDERSON
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 1:130 N BALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4467
Mailing Address - Country:US
Mailing Address - Phone:972-429-9090
Mailing Address - Fax:972-429-7676
Practice Address - Street 1:117 N BALLARD AVE
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4488
Practice Address - Country:US
Practice Address - Phone:972-429-9090
Practice Address - Fax:972-429-7676
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7085TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMO153752OtherDPS
TXMD1639268OtherDEA
TX8F24200Medicare PIN
TXP00862506Medicare PIN
TXMO153752OtherDPS