Provider Demographics
NPI:1205816063
Name:BEER, TERESA S (OD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:S
Last Name:BEER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 25TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4947
Mailing Address - Country:US
Mailing Address - Phone:970-351-8200
Mailing Address - Fax:970-351-8287
Practice Address - Street 1:1770 25TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4947
Practice Address - Country:US
Practice Address - Phone:970-351-8200
Practice Address - Fax:970-351-8287
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08013815Medicaid
CO08013815Medicaid
CO1239680001Medicare NSC
COU56680Medicare UPIN