Provider Demographics
NPI:1144358060
Name:DR RUSSELL BEATTIE
Entity type:Organization
Organization Name:DR RUSSELL BEATTIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:WILLS
Authorized Official - Last Name:BEATTIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:540-894-5600
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117
Mailing Address - Country:US
Mailing Address - Phone:540-894-5600
Mailing Address - Fax:540-894-8013
Practice Address - Street 1:131 LOUISA AVE
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117
Practice Address - Country:US
Practice Address - Phone:540-894-5600
Practice Address - Fax:540-894-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty