Individual provider · NPI-1
Herbert Michael Beasley Jr.
Technician/Technologist, Optician · Destin, FL
NPI number1477311017
StatusActive
Last updated in NPPESMar 8, 2024
Details
- NPI
- 1477311017
- Entity type
- Individual (NPI-1)
- Name
- Herbert Michael Beasley Jr.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 8, 2024
- Certification date
- Mar 8, 2024
- Last updated
- Mar 8, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | DO5886 | FL | Yes |
Practice location
15017 Emerald Coast PkwyDestin, FL 32541-3358
Phone 850-650-0353
Mailing address
15017 Emerald Coast PkwyDestin, FL 32541-3358
Phone 850-650-0353
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