MEDICARE: BRIAN KERPER OPTOMETRIC PHYSICIANS LLC

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	27OA00582700	NJ

General Provider Information

NPI Number	:	1912398892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN KERPER OPTOMETRIC PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	3301 ROUTE 9 S
Second Line	:	UNIT 1
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1636
Country	:	US
Telephone Number	:	609-463-1800
Fax Number	:	609-463-8811

Provider Business Practice Location Address
First Line	:	3301 ROUTE 9 S
Second Line	:	UNIT 1
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1636
Country	:	US
Telephone Number	:	609-463-1800
Fax Number	:	609-463-8811

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. BRIAN KERPER
Credential	:	O.D.
Telephone Number	:	609-463-1800

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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