Healthcare Provider Details

I. General information

NPI: 1063521201
Provider Name (Legal Business Name): NICOLE L BEEDLE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 N MILLS AVE
ORLANDO FL
32803-5313
US

IV. Provider business mailing address

519 N MILLS AVE
ORLANDO FL
32803-5313
US

V. Phone/Fax

Practice location:
  • Phone: 407-447-7739
  • Fax: 407-896-6547
Mailing address:
  • Phone: 407-463-5280
  • Fax: 407-896-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC3209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: