Healthcare Provider Details

I. General information

NPI: 1467648345
Provider Name (Legal Business Name): SCOTT W BEEVE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 VERDUGO BLVD SUITE 150
GLENDALE CA
91208-1402
US

IV. Provider business mailing address

1809 VERDUGO BLVD SUITE 150
GLENDALE CA
91208-1402
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-8001
  • Fax: 818-790-7757
Mailing address:
  • Phone: 818-790-8001
  • Fax: 818-790-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberA71788
License Number StateCA

VIII. Authorized Official

Name: SCOTT WILLIAM BEEVE
Title or Position: OWNER
Credential:
Phone: 818-790-8001