Provider Demographics
NPI:1033214192
Name:BEYLUS, KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:BEYLUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 164TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3176
Mailing Address - Country:US
Mailing Address - Phone:718-380-3280
Mailing Address - Fax:
Practice Address - Street 1:6750 164TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3176
Practice Address - Country:US
Practice Address - Phone:718-380-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUVOO5342-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC22892Medicare PIN