Provider Demographics
NPI:1306882600
Name:BEACH, LARRY LEON (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEON
Last Name:BEACH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3915 TALBOT RD S
Mailing Address - Street 2:SUITE 209
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5738
Mailing Address - Country:US
Mailing Address - Phone:425-235-9911
Mailing Address - Fax:425-254-8807
Practice Address - Street 1:3915 TALBOT RD S
Practice Address - Street 2:SUITE 209
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5738
Practice Address - Country:US
Practice Address - Phone:425-235-9911
Practice Address - Fax:425-254-8807
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001150152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025096Medicaid
WA2025096Medicaid
ALT01974Medicare UPIN