MEDICARE: CARLA ELIZABETH BEATTY OPTICIAN

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	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1015681000001	OTHER	PA	DEPT OF WELFARE

General Provider Information

NPI Number	:	1790906022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA ELIZABETH BEATTY OPTICIAN

Provider Business Mailing Address
First Line	:	2708 BROWNSVILLE RD
Second Line	:	MELROSE PROFESSIONAL BLDG
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-2035
Country	:	US
Telephone Number	:	412-882-5115
Fax Number	:	412-882-4606

Provider Business Practice Location Address
First Line	:	2708 BROWNSVILLE RD
Second Line	:	MELROSE PROFESSIONAL BLDG
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-2035
Country	:	US
Telephone Number	:	412-882-5115
Fax Number	:	412-882-4606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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