Provider Demographics
NPI:1992895965
Name:TRAVIS, BETH ANN (OD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:TRAVIS
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 1:2098 TREMONT CTR
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3108
Mailing Address - Country:US
Mailing Address - Phone:614-486-5205
Mailing Address - Fax:
Practice Address - Street 1:2098 TREMONT CTR
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-3108
Practice Address - Country:US
Practice Address - Phone:614-486-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4973152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU78391Medicare UPIN
OH0888542Medicare PIN