Provider Demographics
NPI:1023468592
Name:BEAVER, ERICA (OD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:BEAVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2534
Mailing Address - Country:US
Mailing Address - Phone:717-632-6063
Mailing Address - Fax:
Practice Address - Street 1:250 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2534
Practice Address - Country:US
Practice Address - Phone:717-632-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003153152W00000X
MDTA2559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist