Provider Demographics
NPI:1952492647
Name:BEUTE, STACY ELISE (OD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ELISE
Last Name:BEUTE
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 1:1728 W ROSCOE ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1082
Mailing Address - Country:US
Mailing Address - Phone:708-456-3232
Mailing Address - Fax:708-456-3371
Practice Address - Street 1:7310 W NORTH AVE STE 2H
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4212
Practice Address - Country:US
Practice Address - Phone:708-456-3232
Practice Address - Fax:708-456-3371
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633693OtherBLUE CROSS/BLUE SHIELD
ILU83826Medicare UPIN