Provider Demographics
NPI:1710982715
Name:BECKER, ANDREA S (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:BECKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:B
Other - Last Name:SEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-0460
Mailing Address - Country:US
Mailing Address - Phone:231-271-4544
Mailing Address - Fax:
Practice Address - Street 1:200 S. CEDAR ST.
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682
Practice Address - Country:US
Practice Address - Phone:231-271-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D566820OtherBCBS PIN
MIP14160001Medicare ID - Type Unspecified