Provider Demographics
NPI:1780882712
Name:STACY BEUTE, LTD.
Entity type:Organization
Organization Name:STACY BEUTE, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:BEUTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-456-3232
Mailing Address - Street 1:7310 W NORTH AVE STE 2H
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4212
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU83826Medicare UPIN