Healthcare Provider Details

I. General information

NPI: 1932259777
Provider Name (Legal Business Name): BETH ANN WALMER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W PENN AVE
CLEONA PA
17042-3230
US

IV. Provider business mailing address

233 W PENN AVE
CLEONA PA
17042-3230
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-0581
  • Fax:
Mailing address:
  • Phone: 717-272-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000209
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: