Provider Demographics
NPI:1376561258
Name:BEAHM, BENJAMIN JASON (OD)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JASON
Last Name:BEAHM
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 1:210 UNIVERSITY BLVD
Mailing Address - Street 2:#A
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3748
Mailing Address - Country:US
Mailing Address - Phone:540-434-2467
Mailing Address - Fax:
Practice Address - Street 1:210 UNIVERSITY BLVD
Practice Address - Street 2:#A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3748
Practice Address - Country:US
Practice Address - Phone:540-434-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA032146OtherANTHEM BCBS
T21913Medicare UPIN