Healthcare Provider Details

I. General information

NPI: 1770026643
Provider Name (Legal Business Name): BECKER OPTOMETRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MARKET DR
PERHAM MN
56573-2116
US

IV. Provider business mailing address

222 MARKET DR
PERHAM MN
56573-2116
US

V. Phone/Fax

Practice location:
  • Phone: 218-346-3073
  • Fax: 218-346-3074
Mailing address:
  • Phone: 218-346-3073
  • Fax: 218-346-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2951
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: COREY L BECKER
Title or Position: PRESIDENT
Credential: OD
Phone: 218-346-3073