Provider Demographics
NPI:1578540092
Name:AHLQUIST, BETSY KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:KAY
Last Name:AHLQUIST
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 1:45 MANOR HILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1538
Mailing Address - Country:US
Mailing Address - Phone:330-702-3937
Mailing Address - Fax:330-702-1911
Practice Address - Street 1:45 MANOR HILL DR STE 100
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1538
Practice Address - Country:US
Practice Address - Phone:330-702-3937
Practice Address - Fax:330-702-1911
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH203087468OtherEMERALD HEALTH
OH000000382418OtherANTHEM
OH0007263805OtherAETNA
OH203087468OtherPRM
OH203087468OtherVSP
OH2559651OtherUNITED HEALTH CARE
OHAE46375OtherSPECTERA
OH203087468027OtherCARESOURCE
OH5779650001OtherMEDICARE DME
OHOH5455OtherEYEMED
OH2594492Medicaid
OHOH05455OtherVBA
OH55612OtherDAVIS VISION
OH7450445OtherCIGNA
OHP00319616OtherMEDICARE RAILROAD
OHOH05455OtherVBA
OH55612OtherDAVIS VISION