Individual provider Active NPI

Daniel R Beckner

  • Optometrist
  • Island City, OR
National Provider Identifier
1205804275
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3035AT Issued in OR
Practice address
10709 S Walton Rd
Island City, OR 97850-8490
Phone
(541) 962-7753
Fax
(541) 963-0750
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3035AT OR Primary

Addresses

Primary practice location

10709 S Walton Rd
Island City, OR 97850-8490

Mailing address

10709 S Walton Rd
Island City, OR 97850-8490
Phone (541) 962-7753

Other identifiers 2

IdentifierTypeStateIssuer
122908MedicaidOR
4821750001OtherORCIGNA GOV. SERVICES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040824000057 OR Practitioner - Optometry 7315910577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1993
Medicare assignment
May accept Medicare assignment
Group practices
Apple Eyecare PCGroup PAC ID 5799758959, 3 clinicians

Practice addresses (Care Compare)

10709 S Walton Rd
Island City, OR 97850-8490
Phone (541) 962-7753

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3035ORMDCounseling Psychologist
3035ATORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Apple Eyecare PC Optometrist CurrentSince Apr 20, 2001 Accepting new patients

Locations

109 Elm St
La Grande, OR 97850
Phone (541) 962-7753

10709 S Walton Rd
La Grande, OR 97850
Phone (541) 962-7753

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1205804275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10709 S WALTON RD",
            "city": "ISLAND CITY",
            "state": "OR",
            "postal_code": "978508490",
            "telephone_number": "541-962-7753",
            "fax_number": "541-963-0750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10709 S WALTON RD",
            "city": "ISLAND CITY",
            "state": "OR",
            "postal_code": "978508490",
            "telephone_number": "541-962-7753",
            "fax_number": "541-963-0750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKNER",
        "first_name": "DANIEL",
        "middle_name": "R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3035AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122908",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GOV. SERVICES",
            "identifier": "4821750001",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Island City, OR

Sources for this page

Verify at the official NPI Registry.