Basic Information
| Provider Information | |||||||||
| NPI: | 1205836525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | TURNEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5615 S NC 41 HWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WALLACE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284666216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102855050 | ||||||||
| FaxNumber: | 9102852968 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 RACINE DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284038702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103956050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1488 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 410048232 | 01 | NC | RR MEDICARE INDIVIDUAL # | OTHER | 410032675 | 01 | NC | RR MEDICARE INDIVIDUAL # | OTHER | 0904T | 01 | NC | BCBS PROV # | OTHER | 890904T | 05 | NC | MEDICAID |