Provider Demographics
NPI:1093711582
Name:BEELER, DAVID BRADLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRADLEY
Last Name:BEELER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:306 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2635
Mailing Address - Country:US
Mailing Address - Phone:936-258-0020
Mailing Address - Fax:936-257-8111
Practice Address - Street 1:306 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2635
Practice Address - Country:US
Practice Address - Phone:936-258-0020
Practice Address - Fax:936-257-8111
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2281TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129179107Medicaid
TX129179106Medicaid
TX129179106Medicaid
TX8B8227Medicare PIN
TX8B1632Medicare ID - Type UnspecifiedBERKELEY EYE INSTITUTE
TX129179106Medicaid
4349865OtherAETNA
TX129179107Medicaid
TX81013QOtherBLUE CROSS BLUE SHIELD
907379OtherBLOCK VISION
TX8B8227Medicare ID - Type Unspecified