Healthcare Provider Details

I. General information

NPI: 1396313722
Provider Name (Legal Business Name): COURTNEY LYNN BEAUMONT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LYNN SANDIFER

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 MALL RING RD
SEBRING FL
33870-8515
US

IV. Provider business mailing address

919 MALL RING RD
SEBRING FL
33870-8515
US

V. Phone/Fax

Practice location:
  • Phone: 863-658-0645
  • Fax:
Mailing address:
  • Phone: 863-658-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: