Provider Demographics
NPI:1811906597
Name:BECK, RICHARD JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:BECK
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 1:2074 LAKE TAHOE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SO LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150
Mailing Address - Country:US
Mailing Address - Phone:530-541-2030
Mailing Address - Fax:530-541-3947
Practice Address - Street 1:2074 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SO LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150
Practice Address - Country:US
Practice Address - Phone:530-541-2030
Practice Address - Fax:530-541-3947
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4685T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ75623ZOtherMEDICARE GROUP PROVIDER#
CA410015213OtherRAILROAD MEDICARE
MB0748561OtherDEA
SDO046850Medicare PIN
CA410015213OtherRAILROAD MEDICARE