Provider Demographics
NPI:1093950693
Name:BECKEN, BRANDON LEE (OD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:BECKEN
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 1:18739 E BRAEBURN LN
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6461
Mailing Address - Country:US
Mailing Address - Phone:480-282-1736
Mailing Address - Fax:480-457-1960
Practice Address - Street 1:21055 E RITTENHOUSE RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4477
Practice Address - Country:US
Practice Address - Phone:480-457-1958
Practice Address - Fax:480-457-1960
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-OPT-LIC-2800152W00000X
UT100836529934152W00000X
CT003006152W00000X
WA60696160152W00000X
VA0618002534152W00000X
COOPT0003259152W00000X
IDODP-100384152W00000X
OR4066AT152W00000X
WI3591-35152W00000X
IN18004200A152W00000X
OHOPT.0003259152W00000X
AZ1635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist