Provider Demographics
NPI:1427111319
Name:BEEBE, MARTHA C (OD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:BEEBE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5114
Mailing Address - Country:US
Mailing Address - Phone:314-965-0329
Mailing Address - Fax:314-822-4976
Practice Address - Street 1:1042 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7200
Practice Address - Country:US
Practice Address - Phone:314-822-4952
Practice Address - Fax:314-822-4952
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist