Healthcare Provider Details

I. General information

NPI: 1245665348
Provider Name (Legal Business Name): ELLEN M BEEBE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 E WASHINGTON AVE STE 101
MADISON WI
53703-2936
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

V. Phone/Fax

Practice location:
  • Phone: 608-441-3939
  • Fax: 608-405-5112
Mailing address:
  • Phone: 505-828-4923
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4066-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: