Healthcare Provider Details

I. General information

NPI: 1265631139
Provider Name (Legal Business Name): MELISSA A BEATY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 W SAHARA AVE SUITE 101
LAS VEGAS NV
89117-4800
US

IV. Provider business mailing address

9011 W. SAHARA AVENUE SUITE 101
LAS VEGAS NV
89117-4801
US

V. Phone/Fax

Practice location:
  • Phone: 702-792-3937
  • Fax: 702-732-4108
Mailing address:
  • Phone: 702-792-3937
  • Fax: 702-732-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number580
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: