Individual
GUY RANDALL BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4314 W. BRAKER LN, SUITE 215, SPRING, TX 78757-0000
(512) 327-4123
(512) 327-9156
Mailing address
4314 W. BRAKER LN, SUITE 215, SPRING, TX 78757-0000
(512) 327-4123
(512) 327-9156
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3914TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00308V
MEDICARE GROUP PTAN
TX
Enumeration date
05/09/2006
Last updated
09/12/2013
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