MEDICARE: MELISSA A. BEATY, O.D., PROFESSIONAL CORPORATION

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	580	NV

General Provider Information

NPI Number	:	1881889426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA A. BEATY, O.D., PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	9011 W SAHARA AVE
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4800
Country	:	US
Telephone Number	:	702-792-3937
Fax Number	:	702-732-4108

Provider Business Practice Location Address
First Line	:	9011 W SAHARA AVE
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4800
Country	:	US
Telephone Number	:	702-792-3937
Fax Number	:	702-732-4108

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. MELISSA A BEATY
Credential	:	O.D.
Telephone Number	:	702-792-3937

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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