Provider Demographics
NPI:1710290754
Name:BECKETT, TAMARA ALANNA (OD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ALANNA
Last Name:BECKETT
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 1:216 CORDER RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3604
Mailing Address - Country:US
Mailing Address - Phone:478-923-5872
Mailing Address - Fax:478-929-6266
Practice Address - Street 1:216 CORDER RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3604
Practice Address - Country:US
Practice Address - Phone:478-923-5872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist