Individual
STACEY BECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1850 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1368
(765) 743-3132
(765) 743-2455
Mailing address
1601 NORTHWESTERN AVE, WEST LAFAYETTE, IN 47906-2268
(765) 464-8573
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003044A
IN
152WC0802X
Corneal and Contact Management Optometrist
18003044B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200269560
—
IN
Enumeration date
07/05/2006
Last updated
08/04/2020
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