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NPI Code Detail

MEDICARE: DR. JESSE C BEASLEY OD

MEDICARE: DR. JESSE C BEASLEY OD
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
1152W00000XOptometrist3990CA

General Provider Information

NPI Number : 1457434409
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE C BEASLEY OD
Provider Business Mailing Address
First Line : 10024 S VERMONT AVE # 2
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-3112
Country : US
Telephone Number : 323-756-1114
Fax Number : 323-756-1155
Provider Business Practice Location Address
First Line : 10024 S VERMONT AVE # 2
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-3112
Country : US
Telephone Number : 323-756-1114
Fax Number : 323-756-1155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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