Provider Demographics
NPI:1467803254
Name:BEEN, TRAVIS MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:BEEN
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 1:14 CHAMPLAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9312
Mailing Address - Country:US
Mailing Address - Phone:608-347-9108
Mailing Address - Fax:
Practice Address - Street 1:914 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2240
Practice Address - Country:US
Practice Address - Phone:847-855-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist