Provider Demographics
NPI:1639399504
Name:BEAUCHAMP, CYNTHIA LAIS (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LAIS
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 DOUGLAS AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5923
Mailing Address - Country:US
Mailing Address - Phone:214-369-6434
Mailing Address - Fax:214-696-6273
Practice Address - Street 1:8222 DOUGLAS AVE
Practice Address - Street 2:STE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5923
Practice Address - Country:US
Practice Address - Phone:214-369-6434
Practice Address - Fax:214-696-6273
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2557207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ941OtherBLUE CROSS BLUE SHIELD
TX8K9536Medicare PIN
TX8AQ941OtherBLUE CROSS BLUE SHIELD