MEDICARE: DR. BRIAN KERPER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00582700	NJ

General Provider Information

NPI Number	:	1669599635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN KERPER O.D.

Provider Business Mailing Address
First Line	:	424A S REDWOOD AVE
Second Line	:
City	:	GALLOWAY
State	:	NJ
Zip	:	08205-4533
Country	:	US
Telephone Number	:	609-748-3451
Fax Number	:	609-748-5152

Provider Business Practice Location Address
First Line	:	3301 ROUTE 9 S
Second Line	:
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1636
Country	:	US
Telephone Number	:	609-463-1800
Fax Number	:	609-463-8811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	02/12/2015

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