MEDICARE: DR. BETH ANN TRAVIS 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	4973	OH
2	152WL0500X	Low Vision Rehabilitation Optometrist	4973	OH

General Provider Information

NPI Number	:	1992895965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH ANN TRAVIS O.D.

Provider Business Mailing Address
First Line	:	2098 TREMONT CTR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-3108
Country	:	US
Telephone Number	:	614-486-5205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2098 TREMONT CTR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-3108
Country	:	US
Telephone Number	:	614-486-5205
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	10/15/2010

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