Provider Demographics
NPI:1609801398
Name:BEARDS, DOUGLAS (M D)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:BEARDS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E HARTSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2806
Mailing Address - Country:US
Mailing Address - Phone:914-948-0025
Mailing Address - Fax:
Practice Address - Street 1:80 E HARTSDALE AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2806
Practice Address - Country:US
Practice Address - Phone:914-948-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116541207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
330681Medicare ID - Type Unspecified
B13159Medicare UPIN