Basic Information
| Provider Information | |||||||||
| NPI: | 1467507335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEATTIE | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | CANFIELD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7826 SW CAPITOL HWY | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972192466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032447788 | ||||||||
| FaxNumber: | 5032442809 | ||||||||
| Practice Location | |||||||||
| Address1: | 7826 SW CAPITOL HWY | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972192466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032447788 | ||||||||
| FaxNumber: | 5032442809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1416 ATI | OR | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 231122 | 01 | OR | EYEMED | OTHER | 3841000 | 01 | OR | BLUE CROSS | OTHER |