Healthcare Provider Details

I. General information

NPI: 1114278447
Provider Name (Legal Business Name): JASON BESECKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3752 E AMITY AVE STE 103
NAMPA ID
83687-1221
US

IV. Provider business mailing address

3752 E AMITY AVE STE 103
NAMPA ID
83687-1221
US

V. Phone/Fax

Practice location:
  • Phone: 208-490-8823
  • Fax: 208-490-8525
Mailing address:
  • Phone: 208-490-8823
  • Fax: 208-490-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100254
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4943
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: