Provider Demographics
NPI:1144406554
Name:BECKER VISION CENTER S.C.
Entity Type:Organization
Organization Name:BECKER VISION CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-424-3937
Mailing Address - Street 1:2411 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5853
Mailing Address - Country:US
Mailing Address - Phone:715-424-3937
Mailing Address - Fax:715-423-3330
Practice Address - Street 1:2411 3RD ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5853
Practice Address - Country:US
Practice Address - Phone:715-424-3937
Practice Address - Fax:715-423-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1785-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38518900Medicaid
WI38518900Medicaid
WI0327730001Medicare NSC
WIT61454Medicare UPIN