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General NPI Number Information
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NPI Number | 1124105325
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Entity Type | Organization
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Legal Business Name | BEAVER EYEWEAR, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 1705 WARREN AVE
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-2647
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Country | US
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Telephone | 570-322-1220
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Fax | 570-322-3454
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Provider Business Mailing Address
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Address Line | 1705 WARREN AVE
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-2647
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Country | US
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Telephone | 570-322-1220
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Fax | 570-322-3454
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | MR. THOMAS E. BEAVER
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Credential |
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Telephone | 570-322-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | NOT APPLICABLE
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License Number State | PA
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