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General NPI Number Information
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NPI Number | 1114934965
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Entity Type | Individual
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Provider Name | ROBERT MATHEW BECKER OD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 155 E COURTLAND ST
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City | MORTON
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State | IL
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Zip | 61550-8931
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Country | US
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Telephone | 309-263-6747
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Fax | 309-263-6744
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Provider Business Mailing Address
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Address Line | 6135 S GREENWOOD AVE APT 3S
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City | CHICAGO
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State | IL
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Zip | 60637-2721
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Country | US
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Telephone | 203-687-6531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002632
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010410
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License Number State | IL
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