Provider Demographics
NPI:1598829657
Name:BECKMAN, KATHRYN A (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:621 S HAM LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3533
Mailing Address - Country:US
Mailing Address - Phone:209-367-1000
Mailing Address - Fax:209-367-1089
Practice Address - Street 1:5238 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2459
Practice Address - Country:US
Practice Address - Phone:931-489-1950
Practice Address - Fax:931-489-1953
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN3131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0104710Medicare PIN
CAU59736Medicare UPIN