Provider Demographics
NPI:1033514278
Name:BECKER EYE CARE
Entity Type:Organization
Organization Name:BECKER EYE CARE
Other - Org Name:DAVID L BECKER OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-278-3881
Mailing Address - Street 1:35 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2054
Mailing Address - Country:US
Mailing Address - Phone:517-278-3881
Mailing Address - Fax:517-279-7311
Practice Address - Street 1:35 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2054
Practice Address - Country:US
Practice Address - Phone:517-278-3881
Practice Address - Fax:517-279-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M31940OtherMEDICARE PTAN
T33086Medicare UPIN