Individual
MR. STEPHEN A BEALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
3001 N ASHLEY ST, VALDOSTA, GA 31602-1709
(229) 247-8484
Mailing address
3001 N ASHLEY ST, VALDOSTA, GA 31602-1709
(229) 247-8484
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO000598
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366429599
CORPORATION NPI
GA
Enumeration date
04/30/2018
Last updated
04/30/2018
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