Provider Demographics
NPI:1316004575
Name:BEEMER, DOUGLAS CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:BEEMER
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 1:100 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2036
Mailing Address - Country:US
Mailing Address - Phone:605-224-0404
Mailing Address - Fax:605-224-8026
Practice Address - Street 1:100 W CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2036
Practice Address - Country:US
Practice Address - Phone:605-224-0404
Practice Address - Fax:605-224-8026
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201332Medicaid
SD6360910001Medicare NSC
SDS103968Medicare PIN
SD9201332Medicaid