MEDICARE: DANIEL R BECKNER

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
1	152W00000X	Optometrist	3035AT	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4821750001	OTHER	OR	CIGNA GOV. SERVICES

General Provider Information

NPI Number	:	1205804275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL R BECKNER

Provider Business Mailing Address
First Line	:	10709 S WALTON RD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850-8490
Country	:	US
Telephone Number	:	541-962-7753
Fax Number	:	541-963-0750

Provider Business Practice Location Address
First Line	:	10709 S WALTON RD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850-8490
Country	:	US
Telephone Number	:	541-962-7753
Fax Number	:	541-963-0750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/13/2012

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Directions to “ DANIEL R BECKNER ” Practice Location

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