Provider Demographics
NPI:1720261886
Name:BECKER EYE CARE CENTER, LLC
Entity Type:Organization
Organization Name:BECKER EYE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-827-0009
Mailing Address - Street 1:2200 EXECUTIVE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2582
Mailing Address - Country:US
Mailing Address - Phone:757-827-0009
Mailing Address - Fax:757-827-2820
Practice Address - Street 1:2200 EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2582
Practice Address - Country:US
Practice Address - Phone:757-827-0009
Practice Address - Fax:757-827-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010240905Medicaid
VAC09699Medicare PIN
VA010240905Medicaid
VA5606500001Medicare NSC