Provider Demographics
NPI:1861527699
Name:BECVAR OPTOMETRY, LLC
Entity type:Organization
Organization Name:BECVAR OPTOMETRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:BECVAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-893-4223
Mailing Address - Street 1:823 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3893
Mailing Address - Country:US
Mailing Address - Phone:573-893-4223
Mailing Address - Fax:573-893-6214
Practice Address - Street 1:823 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3893
Practice Address - Country:US
Practice Address - Phone:573-893-4223
Practice Address - Fax:573-893-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004020693332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504030008Medicaid
MO504030008Medicaid
MO000014557Medicare PIN