Provider Demographics
NPI:1912398892
Name:BRIAN KERPER OPTOMETRIC PHYSICIANS LLC
Entity Type:Organization
Organization Name:BRIAN KERPER OPTOMETRIC PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-463-1800
Mailing Address - Street 1:3301 ROUTE 9 S
Mailing Address - Street 2:UNIT 1
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1636
Mailing Address - Country:US
Mailing Address - Phone:609-463-1800
Mailing Address - Fax:609-463-8811
Practice Address - Street 1:3301 ROUTE 9 S
Practice Address - Street 2:UNIT 1
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1636
Practice Address - Country:US
Practice Address - Phone:609-463-1800
Practice Address - Fax:609-463-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00582700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU93797Medicare UPIN