Provider Demographics
NPI:1821066911
Name:BEATY EYE CLINIC & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BEATY EYE CLINIC & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-479-3331
Mailing Address - Street 1:208 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-4064
Mailing Address - Country:US
Mailing Address - Phone:843-479-3331
Mailing Address - Fax:843-479-3355
Practice Address - Street 1:208 BROAD ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-4064
Practice Address - Country:US
Practice Address - Phone:843-479-3331
Practice Address - Fax:843-479-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9750Medicaid
SC7557Medicare ID - Type Unspecified
SC4958940001Medicare NSC