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General NPI Number Information
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NPI Number | 1285949750
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Entity Type | Organization
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Legal Business Name | WALTER BECKFORD OD
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 461 ROUTE 10 SUITE 29
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City | LEDGEWOOD
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State | NJ
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Zip | 07852
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Country | US
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Telephone | 973-252-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 88 E MAIN ST #200
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City | MENDHAM
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State | NJ
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Zip | 07945-1832
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Country | US
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Telephone | 973-252-4600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALTER MARIO BECKFORD
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Credential | OD
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Telephone | 973-252-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00505200
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License Number State | NJ
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