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NPI Code Detail

MEDICARE: MR. ROBERT BECERRA

MEDICARE: MR. ROBERT BECERRA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician009442-1NY

General Provider Information

NPI Number : 1609382993
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT BECERRA
Provider Business Mailing Address
First Line : 6438 BASILE ROWE
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-3900
Country : US
Telephone Number : 315-434-9168
Fax Number : 315-434-9182
Provider Business Practice Location Address
First Line : 6438 BASILE ROWE
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-3900
Country : US
Telephone Number : 315-434-9168
Fax Number : 315-434-9182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2017
Last Update Date : 12/21/2017

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