Provider Demographics
NPI:1871763755
Name:WILLIAM R BEYER JR, OD
Entity type:Organization
Organization Name:WILLIAM R BEYER JR, OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:609-586-0273
Mailing Address - Street 1:395 HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-586-0273
Mailing Address - Fax:609-586-7018
Practice Address - Street 1:395 HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-586-0273
Practice Address - Fax:609-586-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00411600152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ507572Medicare PIN
NJU19744Medicare UPIN
NJ0512750001Medicare NSC