Provider Demographics
NPI:1952372716
Name:BEAMER, JUSTIN WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WILLIAM
Last Name:BEAMER
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 1:19 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1716
Mailing Address - Country:US
Mailing Address - Phone:717-248-5678
Mailing Address - Fax:717-242-2716
Practice Address - Street 1:19 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1716
Practice Address - Country:US
Practice Address - Phone:717-248-5678
Practice Address - Fax:717-242-2716
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V06354Medicare UPIN
094166W2WMedicare PIN