Provider Demographics
NPI:1831249788
Name:BECK, JANIS E (OD)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:E
Last Name:BECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N LOUISIANA ST # A-744
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7171
Mailing Address - Country:US
Mailing Address - Phone:509-591-9277
Mailing Address - Fax:509-737-8935
Practice Address - Street 1:1220 N COLUMBIA CENTER BLVD STE H
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1145
Practice Address - Country:US
Practice Address - Phone:509-591-9277
Practice Address - Fax:509-737-8935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8933831OtherMEDICARE PTAN
WA1092921Medicaid