Provider Demographics
NPI:1497999585
Name:BEYER OPTICAL
Entity Type:Organization
Organization Name:BEYER OPTICAL
Other - Org Name:EYECARE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-376-8055
Mailing Address - Street 1:4156 ROWAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6116
Mailing Address - Country:US
Mailing Address - Phone:727-376-8055
Mailing Address - Fax:727-376-8425
Practice Address - Street 1:4156 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6116
Practice Address - Country:US
Practice Address - Phone:727-376-8055
Practice Address - Fax:727-376-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2449332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001343100Medicaid
FL6292390001Medicare NSC