Healthcare Provider Details

I. General information

NPI: 1336222124
Provider Name (Legal Business Name): DRS. BECHERER, BECHERER & ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK PLACE PROFESSIONAL CTR.
BELLEVILLE IL
62226-2943
US

IV. Provider business mailing address

1 PARK PLACE PROFESSIONAL CENTRE
BELLEVILLE IL
62226
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-3040
  • Fax: 618-233-3739
Mailing address:
  • Phone: 618-233-3040
  • Fax: 618-233-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046006704
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: PAUL DOUGLAS BECHERER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 618-233-3040