Provider Demographics
NPI:1407859275
Name:BEYER, TODD LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LEE
Last Name:BEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2117
Mailing Address - Country:US
Mailing Address - Phone:330-630-9699
Mailing Address - Fax:330-630-2173
Practice Address - Street 1:518 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2117
Practice Address - Country:US
Practice Address - Phone:330-630-9699
Practice Address - Fax:330-630-2173
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4290207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
40625101OtherUNITED HEALTHCARE
OH0657105Medicaid
000000134337OtherANTHEM
OH180017837OtherRAILROAD MEDICARE
4044067OtherAETNA
OH180017837OtherRAILROAD MEDICARE
OHA17218Medicare UPIN
OH$$$$$$$$$004OtherMEDICAL MUTUAL
OH0657105Medicaid