Basic Information
| Provider Information | |||||||||
| NPI: | 1437262953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKWITT | ||||||||
| FirstName: | JULIE-ANN | ||||||||
| MiddleName: | |||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11100 SW 93RD COURT RD STE 15 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344815188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522912000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11100 SW 93RD COURT RD STE 15 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344815188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522912000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 03/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC1814 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 621342100 | 05 | FL | MEDICAID |