Active NPI
Russell W. Beattie, O.D.
- Optometrist
- Mineral, VA
National Provider Identifier
1215951306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0618000009
- Practice address
- 131 Louisa Ave.
Mineral, VA 23117 - Phone
- (540) 894-5600
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618000009 | VA | Primary |
Addresses
Primary practice location
131 Louisa Ave.
Mineral, VA 23117
Mailing address
PO Box 70
Mineral, VA 23117-0070
Phone (540) 894-5600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 061232 | Other | VA | ANTHEM DOMINION VA POWER |
| 009230041 | Medicaid | VA | |
| 061232 | Other | VA | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207526400000",
"number": "1215951306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70",
"city": "MINERAL",
"state": "VA",
"postal_code": "231170070",
"telephone_number": "540-894-5600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 LOUISA AVE.",
"city": "MINERAL",
"state": "VA",
"postal_code": "23117",
"telephone_number": "540-894-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEATTIE",
"first_name": "RUSSELL",
"middle_name": "W.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2008-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618000009",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM DOMINION VA POWER",
"identifier": "061232",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009230041",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "061232",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mineral, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.