Individual
DR. MARK ADAM BEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1501 WAGNER AVE, GREENVILLE, OH 45331-2763
(937) 547-9012
(937) 547-9361
Mailing address
5526 AUBURN DR, GREENVILLE, OH 45331-9200
(937) 548-3732
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4081/T348
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2298393
—
OH
Enumeration date
08/31/2006
Last updated
08/08/2008
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