Healthcare Provider Details

I. General information

NPI: 1104473537
Provider Name (Legal Business Name): ESPY SPECS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 GOLF RD
EAU CLAIRE WI
54701-8011
US

IV. Provider business mailing address

2720 GOLF RD
EAU CLAIRE WI
54701-8011
US

V. Phone/Fax

Practice location:
  • Phone: 715-318-0906
  • Fax: 715-800-2017
Mailing address:
  • Phone: 715-318-0906
  • Fax: 715-800-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SIOBHAN BEEKSMA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 715-318-0906