Healthcare Provider Details

I. General information

NPI: 1417358268
Provider Name (Legal Business Name): WILLIAM R BEYER JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 HIGHWAY 33
MERCERVILLE NJ
08619-4401
US

IV. Provider business mailing address

395 HIGHWAY 33
MERCERVILLE NJ
08619-4401
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-0273
  • Fax:
Mailing address:
  • Phone: 609-586-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BEYER
Title or Position: OWNER
Credential:
Phone: 609-586-0273