Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT527 | ME |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT527 | ME |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OPT527 | ME |
NPI | 1356337919 |
---|---|
Provider Name | Dr. Pauline V. Beale |
First Address | Lewiston, ME 04240-5626 |
Second Address | Lewiston, ME 04240-5626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002203 | ANTHEM BC/BS (01) | ME |
0324520001 | DME (01) | ME |
T90810 | (02) | ME |