Provider Demographics
NPI:1184315194
Name:BEVERS, JOSHUA C (ABOC221421)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:BEVERS
Suffix:
Gender:M
Credentials:ABOC221421
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7016
Mailing Address - Country:US
Mailing Address - Phone:512-528-0266
Mailing Address - Fax:512-528-8730
Practice Address - Street 1:201 WALTON WAY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7016
Practice Address - Country:US
Practice Address - Phone:512-528-0266
Practice Address - Fax:512-528-8730
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221421156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician