Provider Demographics
NPI:1811949100
Name:WESTELL, BETH (OD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:WESTELL
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 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2209
Practice Address - Country:US
Practice Address - Phone:618-937-2442
Practice Address - Fax:618-932-2875
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0814870018OtherMEDICARE NSC NUMBER
IL046008735Medicaid
IL0814870004OtherMEDICARE NSC NUMBER
IL0814870020OtherMEDICARE NSC NUMBER
IL410039847OtherMEDICARE RAILROAD
051351OtherHEALTH ALLIANCE
IL0814870027OtherMEDICARE NSC NUMBER
IL8735OtherEYEMED
264561OtherHARMONY HEALTH PLAN
IL410039847OtherMEDICARE RAILROAD
ILL71850Medicare PIN