Healthcare Provider Details

I. General information

NPI: 1508977430
Provider Name (Legal Business Name): JEFFREY JOEL BECRAFT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N 2ND ST
NILES MI
49120-2259
US

IV. Provider business mailing address

20 N 2ND ST
NILES MI
49120-2259
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-4040
  • Fax: 269-683-7565
Mailing address:
  • Phone: 269-683-4040
  • Fax: 269-683-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003984
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number4901003984
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: