Provider Demographics
NPI:1366583965
Name:BALLINGER, BETH ELLEN (OD, FCOVD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ELLEN
Last Name:BALLINGER
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Gender:F
Credentials:OD, FCOVD
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Mailing Address - Street 1:901 DOVER DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5538
Mailing Address - Country:US
Mailing Address - Phone:949-642-0292
Mailing Address - Fax:949-642-0298
Practice Address - Street 1:901 DOVER DR
Practice Address - Street 2:STE. 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5538
Practice Address - Country:US
Practice Address - Phone:949-642-0292
Practice Address - Fax:949-642-0298
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA6614T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy