Provider Demographics
NPI:1073631230
Name:COLLIER, BECKY A (OD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:A
Last Name:COLLIER
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 1:1160 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838
Mailing Address - Country:US
Mailing Address - Phone:541-567-6623
Mailing Address - Fax:
Practice Address - Street 1:1160 W ELM AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838
Practice Address - Country:US
Practice Address - Phone:541-567-6623
Practice Address - Fax:541-564-0277
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1339ATI152W00000X
WA1154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR236000Medicaid
T67525Medicare UPIN
OR236000Medicaid