MEDICARE: BEVERLY C. THOMSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00573100	NJ
2	152W00000X	Optometrist	27OA00293200	NJ

General Provider Information

NPI Number	:	1154545994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY C. THOMSON

Provider Business Mailing Address
First Line	:	10 CODINGTON PL
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2408
Country	:	US
Telephone Number	:	908-725-0144
Fax Number	:	908-722-6785

Provider Business Practice Location Address
First Line	:	10 CODINGTON PL
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2408
Country	:	US
Telephone Number	:	908-725-0144
Fax Number	:	908-722-6785

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BEVERLY MILLER
Credential	:	O.D.
Telephone Number	:	908-725-0144

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	04/17/2008

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Directions to “BEVERLY C. THOMSON ” Practice Location

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