Justin Ryan Beavers, O.D.
Individual provider Active NPI Optometrist · Rogers, AR
NPI 1942490263 · NPPES record last updated Aug 1, 2007
Key facts
- NPI
- 1942490263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2596 (AR)
- Practice address
- 4208 Pleasant Crossing Blvd
Rogers, AR 72758 - Phone
- (479) 631-2030
- NPI assigned
- Aug 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4208 S Pleasant Crossing Blvd
Beavers Eye Care
Rogers, AR 72758-1345
Phone (479) 631-2030
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100108000724 | AR | Practitioner - Optometry | 6608913413 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2596 | AR | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beavers Eye Care, Inc. | Optometrist | Current |
Accepting new patients |
Locations
4208 S Pleasant Crossing Blvd
Rogers, AR 72758
Phone (479) 621-0629
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2596 | AR | Yes |
Addresses
Primary practice location
4208 Pleasant Crossing Blvd
Rogers, AR 72758
Mailing address
4208 Pleasant Crossing Blvd
Rogers, AR 72758
Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.