Provider Demographics
NPI:1568556918
Name:BECKER, JEFFREY B (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
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 1:3373 LAKE ARIEL HWY STE C
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1174
Mailing Address - Country:US
Mailing Address - Phone:570-253-6551
Mailing Address - Fax:570-253-6553
Practice Address - Street 1:3373 LAKE ARIEL HWY STE C
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1174
Practice Address - Country:US
Practice Address - Phone:570-253-6551
Practice Address - Fax:570-253-6553
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10732OtherGEISINGER
PA96052OtherVBA
PA2527358OtherAETNA
PA391844OtherNVA
PA0010193480002Medicaid
PABE131412OtherBLUE CROSS BLUE SHIELD
PA818492OtherFIRST PRIORITY
PA96052OtherVBA
PAT29415Medicare UPIN