Provider Demographics
NPI:1740975358
Name:BEACH VISION LLC
Entity type:Organization
Organization Name:BEACH VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-547-9012
Mailing Address - Street 1:1501 WAGNER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-2763
Mailing Address - Country:US
Mailing Address - Phone:937-547-9012
Mailing Address - Fax:937-547-9361
Practice Address - Street 1:1501 WAGNER AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2763
Practice Address - Country:US
Practice Address - Phone:937-547-9012
Practice Address - Fax:937-547-9361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty