Provider Demographics
NPI:1790906022
Name:BEATTY, CARLA ELIZABETH (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ELIZABETH
Last Name:BEATTY
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 BROWNSVILLE RD
Mailing Address - Street 2:MELROSE PROFESSIONAL BLDG
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2035
Mailing Address - Country:US
Mailing Address - Phone:412-882-5115
Mailing Address - Fax:412-882-4606
Practice Address - Street 1:2708 BROWNSVILLE RD
Practice Address - Street 2:MELROSE PROFESSIONAL BLDG
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-2035
Practice Address - Country:US
Practice Address - Phone:412-882-5115
Practice Address - Fax:412-882-4606
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015681000001OtherDEPT OF WELFARE
PA5459150001Medicare ID - Type Unspecified