MEDICARE: THOMAS J. BEASLEY MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	N5884	AR

General Provider Information

NPI Number	:	1083817167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS J. BEASLEY MD PA

Provider Business Mailing Address
First Line	:	1204 N WASHINGTON ST
Second Line	:	PO BOX 1617
City	:	FORREST CITY
State	:	AR
Zip	:	72335-2121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 N WASHINGTON ST
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-2121
Country	:	US
Telephone Number	:	870-633-7742
Fax Number	:

Authorized Official
Title or Position	:	OPHTHALMOLOGIST
Name	:	DR. THOMAS J BEASLEY
Credential	:	MD
Telephone Number	:	870-633-7742

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	03/14/2008

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