Individual
DR. JEREMY VAUGHN BEAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
22 W MAIN ST, WALLA WALLA, WA 99362
(509) 529-2020
(509) 529-2115
Mailing address
PO BOX 1138, WALLA WALLA, WA 99362
(509) 529-2020
(509) 529-2115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2979T
OR
152W00000X
Optometrist
Primary
3912
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0190335
DEPT OF LABOR & INDUSTRY
—
01
—
022886006
REGENCE OREGON
—
01
—
0323400001
MC SUPPLY CIGNA DMERC
—
05
—
2029635
—
WA
01
—
2576
GROUP HEALTH
—
01
—
5485BE
REGENCE WASHINGTON
—
01
—
610605300
DEPT OF LABOR SEATTLE DFE
—
01
—
7666593
AETNA
—
01
—
8886644808
COMMUNITY HEALTH PLAN WA
—
01
—
910940489
COMERCIAL CLAIMS
—
01
—
P00251501
TRAVELERS MEDICARE RETIRE
—
Enumeration date
03/09/2006
Last updated
12/21/2023
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