Provider Demographics
NPI:1114984390
Name:BEEK, LOREN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:MICHAEL
Last Name:BEEK
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 1:4801 S CLIFF AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7015
Mailing Address - Country:US
Mailing Address - Phone:816-478-1230
Mailing Address - Fax:816-350-4585
Practice Address - Street 1:4741 S COCHISE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6974
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:816-350-4585
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-2522152W00000X
NM573152W00000X
MO2016008476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16821092Medicaid
840851676009OtherROCKY MOUNTAIN HEALTH PLANS
C805537Medicare PIN
COV09409Medicare UPIN