Provider Demographics
NPI:1881757474
Name:DRS WALTON & BECKER EYECARE PC
Entity type:Organization
Organization Name:DRS WALTON & BECKER EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-628-3441
Mailing Address - Street 1:89 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4979
Mailing Address - Country:US
Mailing Address - Phone:248-628-3441
Mailing Address - Fax:248-628-5105
Practice Address - Street 1:89 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4979
Practice Address - Country:US
Practice Address - Phone:248-628-3441
Practice Address - Fax:248-628-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF37157OtherBCBC
MI0464090001Medicare NSC
MIOF37157OtherBCBC