Organization
PAUL W BEAVER OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL W BEAVER OD (OPTOMETRIST)
(712) 722-1270
Entity
Organization
Contact information
Practice address
105 S MAIN AVE, SIOUX CENTER, IA 51250-1535
(712) 722-1270
(712) 722-1282
Mailing address
105 S MAIN AVE, SIOUX CENTER, IA 51250-1535
(712) 722-1270
(712) 722-1282
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1885
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0282442
—
IA
01
—
28244
BLUE CROSS
IA
Enumeration date
12/13/2005
Last updated
03/21/2008
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