Active NPI
Genia Gail Beasley, O.D.
- Vision Therapy Optometrist
- Charlotte, NC
National Provider Identifier
1497960736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vision Therapy Optometrist
- License
- 1612
- Practice address
- 6917 Shannon Willow Road
Suite 100
Charlotte, NC 28226 - Phone
- (704) 405-1222
- Fax
- (704) 405-1225
- NPI assigned
- May 11, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Vision Therapy Optometrist | 152WV0400X | 1612 | NC | Primary |
Addresses
Primary practice location
6917 Shannon Willow Road
Suite 100
Charlotte, NC 28226
Mailing address
6917 Shannon Willow Road
Suite 100
Charlotte, NC 28226
Phone (704) 405-1222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1612 | Other | NC | OPTOMETRY STATE LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1612 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497960736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6917 SHANNON WILLOW ROAD",
"address_2": "SUITE 100",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28226",
"telephone_number": "704-405-1222",
"fax_number": "704-405-1225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6917 SHANNON WILLOW ROAD",
"address_2": "SUITE 100",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28226",
"telephone_number": "704-405-1222",
"fax_number": "704-405-1225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEASLEY",
"first_name": "GENIA",
"middle_name": "GAIL",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "NC",
"license": "1612",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTOMETRY STATE LICENSE",
"identifier": "1612",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.