Provider Demographics
NPI:1316900160
Name:BEELEN, TERESA A (OD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:A
Last Name:BEELEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:AMELIA
Other - Last Name:BEELEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:194 BLACK CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7609
Mailing Address - Country:US
Mailing Address - Phone:269-245-7926
Mailing Address - Fax:
Practice Address - Street 1:12765 HARPER VILLAGE DR STE 107
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8376
Practice Address - Country:US
Practice Address - Phone:269-979-2832
Practice Address - Fax:269-979-2855
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRO.D.#455D.P.A.143152W00000X
MI4901004861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI65226-006OtherDAVIS VISION
MI65226-006OtherDAVIS VISION
MI65226-006OtherDAVIS VISION
MI07335000Medicare PIN
PR215914OtherPREFERRED HEALTH PLAN
PR068-0455OtherGLOBAL HEALTH INSURANCE
PR7250320OtherHUMANA INSURANCE (PPO)
PR1316900160OtherTRIPLE S MI SALUD HMO REFORMA
PR56742LUMedicare ID - Type UnspecifiedTRIPLE S OPTIMO