Provider Demographics
NPI:1316965247
Name:BEEDE, ALLEN LEE (OD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:LEE
Last Name:BEEDE
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 1:240 MERIDIAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2927
Mailing Address - Country:US
Mailing Address - Phone:408-294-3722
Mailing Address - Fax:
Practice Address - Street 1:240 MERIDIAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2927
Practice Address - Country:US
Practice Address - Phone:408-294-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111030T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0111030Medicaid
CASD0111030Medicare PIN
CAU76820Medicare UPIN