Provider Demographics
NPI:1770761041
Name:WILLIAM P. BEEAKER, O.D.
Entity type:Organization
Organization Name:WILLIAM P. BEEAKER, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:BEEAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-897-2662
Mailing Address - Street 1:PO BOX F
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-0705
Mailing Address - Country:US
Mailing Address - Phone:207-897-2662
Mailing Address - Fax:
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-0705
Practice Address - Country:US
Practice Address - Phone:207-897-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT550332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0127040001Medicare NSC