Provider Demographics
NPI:1205149788
Name:BECKER, EMILY JEAN (O,D)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:BECKER
Suffix:
Gender:F
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3916
Mailing Address - Country:US
Mailing Address - Phone:316-262-3716
Mailing Address - Fax:316-262-0784
Practice Address - Street 1:1202 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3916
Practice Address - Country:US
Practice Address - Phone:316-262-3716
Practice Address - Fax:316-262-0784
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist