Provider Demographics
NPI:1356305957
Name:DR. BEARDSLEY'S SUPER OPTICAL, INC.
Entity Type:Organization
Organization Name:DR. BEARDSLEY'S SUPER OPTICAL, INC.
Other - Org Name:DR. BEARDSLEY'S SUPER CLINIC, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CERDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-783-5500
Mailing Address - Street 1:317 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4801
Mailing Address - Country:US
Mailing Address - Phone:956-686-7435
Mailing Address - Fax:956-686-6956
Practice Address - Street 1:317 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4801
Practice Address - Country:US
Practice Address - Phone:956-686-7435
Practice Address - Fax:956-686-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189363801Medicaid
TX00W556Medicare UPIN