Provider Demographics
NPI:1780772053
Name:BECHERER, PAUL DOUGLAS (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:BECHERER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK PLACE PROFESSIONAL CTR.
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2943
Mailing Address - Country:US
Mailing Address - Phone:618-233-3040
Mailing Address - Fax:618-233-3739
Practice Address - Street 1:1 PARK PLACE PROFESSIONAL CTR.
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-2943
Practice Address - Country:US
Practice Address - Phone:618-233-3040
Practice Address - Fax:618-233-3739
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006704152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL640731Medicare PIN
ILT37384Medicare UPIN
IL0236230001Medicare NSC
IL580000677Medicare PIN
ILCE1726Medicare PIN