MEDICARE: BEVERLY K ROBERTSON OD PC

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	2804TG	TX

General Provider Information

NPI Number	:	1912158759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY K ROBERTSON OD PC

Provider Business Mailing Address
First Line	:	135 QUITMAN ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1359
Country	:	US
Telephone Number	:	903-856-2382
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 QUITMAN ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1359
Country	:	US
Telephone Number	:	903-856-2382
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BEVERLY ROBERTSON SPEARMAN
Credential	:	O.D.
Telephone Number	:	903-856-2055

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	05/25/2011

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