Provider Demographics
NPI:1083811863
Name:JANET C. WHELAN OD, PA
Entity Type:Organization
Organization Name:JANET C. WHELAN OD, PA
Other - Org Name:BEACON EYECARE, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-284-4231
Mailing Address - Street 1:3 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2917
Mailing Address - Country:US
Mailing Address - Phone:207-284-4231
Mailing Address - Fax:
Practice Address - Street 1:3 BEACON AVE
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2917
Practice Address - Country:US
Practice Address - Phone:207-284-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114690100Medicaid
MEDG9728Medicare PIN
ME114690100Medicaid
ME0609520001Medicare NSC