Provider Demographics
NPI:1306913066
Name:RULON D BEESLEY
Entity type:Organization
Organization Name:RULON D BEESLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RULON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-940-0555
Mailing Address - Street 1:44404 16TH ST W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2839
Mailing Address - Country:US
Mailing Address - Phone:661-940-0555
Mailing Address - Fax:661-940-0558
Practice Address - Street 1:44404 16TH ST W
Practice Address - Street 2:SUITE 102
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2839
Practice Address - Country:US
Practice Address - Phone:661-940-0555
Practice Address - Fax:661-940-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G630311Medicaid
CA5826620001Medicare NSC
CA00G630311Medicaid
CAG63031Medicare PIN