Individual
JEREMY A BEATTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D
Contact information
Practice address
224 S WOODS MILL RD, SUITE 700 SOUTH, CHESTERFIELD, MO 63017-3451
(314) 469-1230
(314) 469-6709
Mailing address
224 S WOODS MILL RD, SUITE 700 SOUTH, CHESTERFIELD, MO 63017-3451
(314) 469-1230
(314) 469-6709
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046009701
IL
152W00000X
Optometrist
Primary
2004019126
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009701
—
IL
01
—
195289
BLUE CROSS BLUE SHIELD
MO
05
—
319173803
—
MO
Enumeration date
12/11/2006
Last updated
02/13/2012
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