Provider Demographics
NPI:1932259777
Name:WALMER, BETH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:WALMER
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 1:233 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEONA
Mailing Address - State:PA
Mailing Address - Zip Code:17042-3230
Mailing Address - Country:US
Mailing Address - Phone:717-272-0581
Mailing Address - Fax:
Practice Address - Street 1:233 W PENN AVE
Practice Address - Street 2:
Practice Address - City:CLEONA
Practice Address - State:PA
Practice Address - Zip Code:17042-3230
Practice Address - Country:US
Practice Address - Phone:717-272-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000209152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69508Medicare UPIN