Individual
ELISE L BEATTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2045 VIRGINIA AVE, CONNERSVILLE, IN 47331-2921
(765) 825-0660
(765) 825-3075
Mailing address
PO BOX 399, RICHMOND, IN 47375-0399
(765) 962-2020
(765) 966-2975
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003182A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200395910
—
IN
05
—
2354241
—
OH
Enumeration date
12/27/2005
Last updated
06/30/2010
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