Provider Demographics
NPI:1063521201
Name:BEEDLE, NICOLE L (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:BEEDLE
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 1:519 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5313
Mailing Address - Country:US
Mailing Address - Phone:407-463-5280
Mailing Address - Fax:407-896-6547
Practice Address - Street 1:519 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5313
Practice Address - Country:US
Practice Address - Phone:407-447-7739
Practice Address - Fax:407-896-6547
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3209152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU71806Medicare UPIN
FLE4590YMedicare PIN