Provider Demographics
NPI:1316925225
Name:BEEAKER, WILLIAM P (OD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:P
Last Name:BEEAKER
Suffix:
Gender:M
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:PO BOX F
Mailing Address - Street 2:32 MAIN ST
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-0705
Mailing Address - Country:US
Mailing Address - Phone:207-897-2662
Mailing Address - Fax:207-897-6272
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-0705
Practice Address - Country:US
Practice Address - Phone:207-897-2662
Practice Address - Fax:207-897-6272
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT550152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131050000Medicaid
MEMM2911Medicare PIN
MET79606Medicare UPIN
ME1770761041Medicare NSC