Provider Demographics
NPI:1013902873
Name:BEACH EYE CARE, INC.
Entity Type:Organization
Organization Name:BEACH EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:PEYTON
Authorized Official - Last Name:NEATROUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-425-5550
Mailing Address - Street 1:1201 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2217
Mailing Address - Country:US
Mailing Address - Phone:757-425-5550
Mailing Address - Fax:757-412-2606
Practice Address - Street 1:1201 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2217
Practice Address - Country:US
Practice Address - Phone:757-425-5550
Practice Address - Fax:757-412-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618002731OtherSTATE LICENSE
VA010147859Medicaid
VACL3147OtherMEDICARE RAILROAD
89015YKOtherNC MEDICAID
VA0317130001Medicare NSC