Provider Demographics
NPI:1558587295
Name:BECKER OPTOMETRY PC
Entity Type:Organization
Organization Name:BECKER OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-230-8890
Mailing Address - Street 1:415 34TH ST N
Mailing Address - Street 2:
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529-1801
Mailing Address - Country:US
Mailing Address - Phone:218-233-9839
Mailing Address - Fax:218-233-9841
Practice Address - Street 1:415 34TH ST N
Practice Address - Street 2:
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1801
Practice Address - Country:US
Practice Address - Phone:218-233-9839
Practice Address - Fax:218-233-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN320M3BEOtherBLUE CROSS BLUE SHIELD MN
MN22-02554OtherMEDICA
C03643OtherORGANIZATION GROUP NUMBER
MN25104OtherSPECTERA
MN091658700Medicaid
MN892871OtherND VISION SERVICES
MNP00263877OtherRAILROAD MEDICARE
MN37839OtherAVESIS
MN49006OtherDAVIS VISION
MNV00592Medicare UPIN
C03643OtherORGANIZATION GROUP NUMBER
MN49006OtherDAVIS VISION