Provider Demographics
NPI:1275974230
Name:BEITER, JAMES GORDON JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GORDON
Last Name:BEITER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1813
Mailing Address - Country:US
Mailing Address - Phone:716-823-6093
Mailing Address - Fax:
Practice Address - Street 1:3861 S PARK AVE
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-1813
Practice Address - Country:US
Practice Address - Phone:716-823-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICODTG00592152W00000X
NY56 008059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist