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General NPI Number Information
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NPI Number | 1548731482
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Entity Type | Individual
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Provider Name | JONATHAN BEESON OD
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Gender | Male
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 411 S BEELINE HWY STE A
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City | PAYSON
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State | AZ
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Zip | 85541-5921
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Country | US
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Telephone | 928-474-3556
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 W COUNTRY CLUB DR
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City | PAYSON
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State | AZ
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Zip | 85541-4603
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Country | US
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Telephone | 928-978-7194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002317
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License Number State | AZ
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