Provider Demographics
NPI:1205858115
Name:BEILER, MARK A (OD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:BEILER
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 1:2560 GULF TO BAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-4421
Mailing Address - Country:US
Mailing Address - Phone:727-799-3772
Mailing Address - Fax:727-791-6598
Practice Address - Street 1:2560 GULF TO BAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-4421
Practice Address - Country:US
Practice Address - Phone:727-799-3772
Practice Address - Fax:727-791-6598
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078260200Medicaid
FL20119POtherPTAN
FL078260200Medicaid