Provider Demographics
NPI:1235180027
Name:BECKER, DAVID L (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
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 1:35 SOUTH MICHIGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036
Mailing Address - Country:US
Mailing Address - Phone:517-278-3881
Mailing Address - Fax:517-279-7311
Practice Address - Street 1:35 SOUTH MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-278-3881
Practice Address - Fax:517-279-7311
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1751989Medicaid
MI0M31940OtherMEDICARE GROUP NUMBER
MI900A265000OtherBCBS
MI0M31940OtherMEDICARE GROUP NUMBER
MI1751989Medicaid