MEDICARE: ANGELA J. BEAL, OD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1144881152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELA J. BEAL, OD, LLC

Provider Business Mailing Address
First Line	:	1527 COTTONWOOD DR
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-7929
Country	:	US
Telephone Number	:	614-565-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 POLARIS PKWY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-2038
Country	:	US
Telephone Number	:	614-846-7336
Fax Number	:	614-846-7552

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	ANGELA JEAN BEAL
Credential	:	OD
Telephone Number	:	614-565-1201

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	11/10/2020

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