Provider Demographics
NPI:1891353348
Name:BEARD, MIRANDA CHAABAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:CHAABAN
Last Name:BEARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:PAIGE
Other - Last Name:CHAABAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 GEMSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3332 PRINCESS ANNE RD STE 611
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2613
Practice Address - Country:US
Practice Address - Phone:757-368-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist