Provider Demographics
NPI:1578513008
Name:BEASLEY, SCOTT L (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3800 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE A 358
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4495
Mailing Address - Country:US
Mailing Address - Phone:253-347-7339
Mailing Address - Fax:
Practice Address - Street 1:3800 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE A 358
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4495
Practice Address - Country:US
Practice Address - Phone:253-347-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VO6226Medicare UPIN