Provider Demographics
NPI:1245453117
Name:BEAL, THOMAS S (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:BEAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36470 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4175
Mailing Address - Country:US
Mailing Address - Phone:440-476-3756
Mailing Address - Fax:
Practice Address - Street 1:26300 CEDAR RD STE 2300
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1185
Practice Address - Country:US
Practice Address - Phone:216-378-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE0604321Medicare ID - Type Unspecified