Provider Demographics
NPI:1417048430
Name:BEISSEL, BRIAN R (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:BEISSEL
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 1:4004 W ST JOSEPH HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4215
Mailing Address - Country:US
Mailing Address - Phone:517-321-1154
Mailing Address - Fax:517-321-2652
Practice Address - Street 1:4004 W ST JOSEPH HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4215
Practice Address - Country:US
Practice Address - Phone:517-321-1154
Practice Address - Fax:517-321-2652
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2200298OtherPHYSICIANS HEALTH PLAN
0P25660Medicare PIN
V07780Medicare UPIN
P25660002Medicare ID - Type Unspecified