Provider Demographics
NPI:1134289739
Name:ROCK, BECKY (OD)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:
Last Name:ROCK
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 1:40 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1205
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-938-2650
Practice Address - Street 1:12603 ILLINOIS HIGHWAY 143
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1194
Practice Address - Country:US
Practice Address - Phone:618-882-4262
Practice Address - Fax:618-882-4263
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018250152W00000X
IL046009698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009698Medicaid
MO318392024Medicaid
ILP00294310Medicare PIN
ILK24072Medicare PIN
V01969Medicare UPIN
MO257294033Medicare PIN
IL046009698Medicaid
MOP00349847Medicare PIN
MO44446001Medicare PIN