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General NPI Number Information
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NPI Number | 1679624332
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Entity Type | Organization
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Legal Business Name | EDWARD C. BEITER, O.D.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 100 WALMART DR VISION CENTER
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City | JACKSON
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State | OH
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Zip | 45640-8692
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Country | US
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Telephone | 740-288-2718
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Fax | 740-288-2720
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Provider Business Mailing Address
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Address Line | 11420 STATE ROUTE 776
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City | JACKSON
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State | OH
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Zip | 45640-8907
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Country | US
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Telephone | 740-286-3100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD C BEITER
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Credential | O.D.
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Telephone | 740-288-2718
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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 | 3054-352
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License Number State | OH
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