Provider Demographics
NPI:1124640412
Name:BEATY, NICOLE L (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:BEATY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BEAN RD
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5106
Mailing Address - Country:US
Mailing Address - Phone:423-716-4831
Mailing Address - Fax:
Practice Address - Street 1:7320 SHALLOWFORD RD # RC
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4941
Practice Address - Country:US
Practice Address - Phone:423-894-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist