Provider Demographics
NPI:1508977430
Name:BECRAFT, JEFFREY JOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOEL
Last Name:BECRAFT
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 1:20 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2259
Mailing Address - Country:US
Mailing Address - Phone:269-683-4040
Mailing Address - Fax:269-683-7565
Practice Address - Street 1:20 N 2ND ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2259
Practice Address - Country:US
Practice Address - Phone:269-683-4040
Practice Address - Fax:269-683-7565
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003984152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4325523Medicaid
U81564Medicare UPIN
MI4325523Medicaid