Provider Demographics
NPI:1982602231
Name:BEAGLEY, SHAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:BEAGLEY
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 1:6456 W DAVIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5727
Mailing Address - Country:US
Mailing Address - Phone:801-512-9108
Mailing Address - Fax:
Practice Address - Street 1:3747 S 2700 W
Practice Address - Street 2:INSIDE COSTCO
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-3721
Practice Address - Country:US
Practice Address - Phone:801-996-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5950051-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist