Provider Demographics
NPI:1518938430
Name:BECKISH, NICOLE M (OD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BECKISH
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 1:618 STATE ROUTE 690
Mailing Address - Street 2:
Mailing Address - City:SPRING BROOK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-6512
Mailing Address - Country:US
Mailing Address - Phone:570-877-1047
Mailing Address - Fax:
Practice Address - Street 1:81 VIEWMONT MALL
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1360
Practice Address - Country:US
Practice Address - Phone:570-344-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000743152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA817607OtherFIRST PRIORITY INSURANCE
PABE1769322OtherBLUE SHIELD INSURANCE
PA2652230OtherAETNA INSURANCE
PA68841OtherGEISINGER INSURANCE
PABE1769322OtherBLUE SHIELD INSURANCE
PA054039Medicare PIN