Provider Demographics
NPI:1679886873
Name:BEARDEN, BETHANY MAYO (OD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:MAYO
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BETHANY
Other - Middle Name:LYNN
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:148 ROLLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-8585
Mailing Address - Country:US
Mailing Address - Phone:731-234-8886
Mailing Address - Fax:
Practice Address - Street 1:2716 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-1560
Practice Address - Country:US
Practice Address - Phone:731-784-9409
Practice Address - Fax:731-784-9418
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist