Provider Demographics
NPI:1184735359
Name:BECKER, COREY (OD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:BECKER
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 1:222 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-2116
Mailing Address - Country:US
Mailing Address - Phone:218-346-3073
Mailing Address - Fax:218-346-3074
Practice Address - Street 1:222 MARKET DR
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-2116
Practice Address - Country:US
Practice Address - Phone:218-346-3073
Practice Address - Fax:218-346-3074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN091658700Medicaid
MN25104OtherSPECTERA
MN49006OtherDAVIS VISION
MN320M3BEOtherBLUE CROSS BLUE SHIELD MN
MN37839OtherAVESIS
MN892871OtherND VISION SERVICES
MNP00263877OtherRAILROAD MEDICARE
MN22-02554OtherMEDICA
MN37839OtherAVESIS
MNP00263877OtherRAILROAD MEDICARE