Provider Demographics
NPI:1972567006
Name:BEATTY, ARTIS LANARD (OD)
Entity Type:Individual
Prefix:
First Name:ARTIS
Middle Name:LANARD
Last Name:BEATTY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:8231 BRIER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7705
Practice Address - Country:US
Practice Address - Phone:919-863-5032
Practice Address - Fax:919-863-5038
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903815Medicaid
NCP00371423OtherRAILROAD MEDICARE
NC093UROtherBLUECROSS
NC5903815Medicaid