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General NPI Number Information
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NPI Number | 1356305957
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Entity Type | Organization
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Legal Business Name | DR. BEARDSLEY'S SUPER OPTICAL, INC.
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 317 S BROADWAY ST
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City | MCALLEN
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State | TX
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Zip | 78501-4801
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Country | US
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Telephone | 956-686-7435
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Fax | 956-686-6956
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Provider Business Mailing Address
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Address Line | 317 S BROADWAY ST
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City | MCALLEN
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State | TX
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Zip | 78501-4801
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Country | US
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Telephone | 956-686-7435
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Fax | 956-686-6956
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JUAN E CERDA
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Credential | O.D.
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Telephone | 956-783-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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