Provider Demographics
NPI:1285949750
Name:WALTER BECKFORD OD
Entity type:Organization
Organization Name:WALTER BECKFORD OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:BECKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-252-4600
Mailing Address - Street 1:88 E MAIN ST
Mailing Address - Street 2:#200
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1832
Mailing Address - Country:US
Mailing Address - Phone:973-252-4600
Mailing Address - Fax:
Practice Address - Street 1:461 ROUTE 10 SUITE 29
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852
Practice Address - Country:US
Practice Address - Phone:973-252-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00505200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty