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NPI Code Detail

MEDICARE: EMILY JEAN BECKER O,D.

MEDICARE: EMILY JEAN BECKER O,D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1864KS

General Provider Information

NPI Number : 1205149788
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY JEAN BECKER O,D.
Provider Business Mailing Address
First Line : 1202 W MAPLE ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-3916
Country : US
Telephone Number : 316-262-3716
Fax Number : 316-262-0784
Provider Business Practice Location Address
First Line : 1202 W MAPLE ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-3916
Country : US
Telephone Number : 316-262-3716
Fax Number : 316-262-0784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2010
Last Update Date : 07/26/2010

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Directions to “ EMILY JEAN BECKER O,D.” Practice Location

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