Provider Demographics
NPI:1982395059
Name:BEAGLEY, MADISON (OD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BEAGLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 POLARIS POINT LOOP APT 132
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3895
Mailing Address - Country:US
Mailing Address - Phone:785-324-1523
Mailing Address - Fax:
Practice Address - Street 1:6075 E PARKWAY DR STE 160
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-5413
Practice Address - Country:US
Practice Address - Phone:720-795-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003914152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist