Provider Demographics
NPI:1578687505
Name:BEYER, JOAN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:BEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:BEYER-DWORSCHACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4011 W GRANGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-3029
Mailing Address - Country:US
Mailing Address - Phone:414-421-2987
Mailing Address - Fax:
Practice Address - Street 1:1540 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4019
Practice Address - Country:US
Practice Address - Phone:414-453-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist