MEDICARE: TAMARA ALANNA BECKETT 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
1	152W00000X	Optometrist	OPT002593	GA

General Provider Information

NPI Number	:	1710290754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA ALANNA BECKETT O.D.

Provider Business Mailing Address
First Line	:	216 CORDER RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-3604
Country	:	US
Telephone Number	:	478-923-5872
Fax Number	:	478-929-6266

Provider Business Practice Location Address
First Line	:	216 CORDER RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-3604
Country	:	US
Telephone Number	:	478-923-5872
Fax Number	:

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

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	05/29/2019

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