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General NPI Number Information
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NPI Number | 1750576856
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Entity Type | Organization
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Legal Business Name | HEATHER BETSKO, LLC
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 777 W SOUTHERN AVE SUITE 515
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City | MESA
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State | AZ
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Zip | 85210-5008
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Country | US
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Telephone | 480-461-3937
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Fax | 480-461-0331
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Provider Business Mailing Address
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Address Line | 745 W BASELINE RD STE 21
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City | MESA
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State | AZ
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Zip | 85210-6023
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Country | US
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Telephone | 480-461-3937
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Fax | 480-461-0331
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. HEATHER R BETSKO
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Credential | OD, FAAO
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Telephone | 480-461-3937
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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 | 1386
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License Number State | AZ
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