Individual
DR. GENIA GAIL BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6917 SHANNON WILLOW ROAD, SUITE 100, CHARLOTTE, NC 28226
(704) 405-1222
(704) 405-1225
Mailing address
6917 SHANNON WILLOW ROAD, SUITE 100, CHARLOTTE, NC 28226
(704) 405-1222
(704) 405-1225
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
1612
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1612
OPTOMETRY STATE LICENSE
NC
Enumeration date
05/11/2007
Last updated
07/08/2007
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