Provider Demographics
NPI:1366429599
Name:BEALL OPTICAL INC
Entity type:Organization
Organization Name:BEALL OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:229-247-8484
Mailing Address - Street 1:3001 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1709
Mailing Address - Country:US
Mailing Address - Phone:229-247-8484
Mailing Address - Fax:229-247-7996
Practice Address - Street 1:3001 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1709
Practice Address - Country:US
Practice Address - Phone:229-247-8484
Practice Address - Fax:229-247-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA598156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5868810001Medicare PIN