Provider Demographics
NPI:1104066067
Name:BEATON, JOHNLEE (OD)
Entity type:Individual
Prefix:DR
First Name:JOHNLEE
Middle Name:
Last Name:BEATON
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 1:3610 S OCEAN BLVD APT 603
Mailing Address - Street 2:
Mailing Address - City:SOUTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-5877
Mailing Address - Country:US
Mailing Address - Phone:305-310-1842
Mailing Address - Fax:
Practice Address - Street 1:9800 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33351-4325
Practice Address - Country:US
Practice Address - Phone:954-475-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist