Provider Demographics
NPI:1760975791
Name:BECKER, KRISTEN LYNN (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:BECKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:915 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-5616
Mailing Address - Country:US
Mailing Address - Phone:785-226-4472
Mailing Address - Fax:
Practice Address - Street 1:1410 E IRON AVE STE 5
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3285
Practice Address - Country:US
Practice Address - Phone:785-825-7271
Practice Address - Fax:785-825-0957
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2080OtherKANSAS STATE BOARD OF EXAMINERS IN OPTOMETRY
14273829OtherCAQH PROVIDER ID