MEDICARE: DR. CAROLINE BEESLEY PATE O.D.

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	152W00000X	Optometrist	SB25	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051523178	OTHER	AL	BCBS
3	V00749	OTHER	AL	VIVA

General Provider Information

NPI Number	:	1912936071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE BEESLEY PATE O.D.

Provider Business Mailing Address
First Line	:	1716 UNIVERSITY BOULEVARD
Second Line	:	HPB G080A
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-0001
Country	:	US
Telephone Number	:	205-975-2020
Fax Number	:	205-934-6755

Provider Business Practice Location Address
First Line	:	1716 UNIVERSITY BOULEVARD
Second Line	:	HPB G080A
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-0001
Country	:	US
Telephone Number	:	205-975-2020
Fax Number	:	205-934-6755

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	06/25/2010

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