Provider Demographics
NPI:1467507335
Name:BEATTIE, JOSEPH CANFIELD (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CANFIELD
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7826 SW CAPITOL HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2466
Mailing Address - Country:US
Mailing Address - Phone:503-244-7788
Mailing Address - Fax:503-244-2809
Practice Address - Street 1:7826 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2466
Practice Address - Country:US
Practice Address - Phone:503-244-7788
Practice Address - Fax:503-244-2809
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1416 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231122OtherEYEMED
OR3841000OtherBLUE CROSS
OR3841000OtherBLUE CROSS