Provider Demographics
NPI:1669599635
Name:KERPER, BRIAN (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:KERPER
Suffix:
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 1:424A S REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4533
Mailing Address - Country:US
Mailing Address - Phone:609-748-3451
Mailing Address - Fax:609-748-5152
Practice Address - Street 1:3301 ROUTE 9 S
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00582700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU93797Medicare UPIN