Provider Demographics
NPI:1104844414
Name:BECVAR, STACY (OD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:BECVAR
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 1:3405 KUNLUN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1109 CLUB VILLAGE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4466
Practice Address - Country:US
Practice Address - Phone:573-441-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004021756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317214906Medicaid
MOU97224Medicare UPIN
MO317214906Medicaid