Provider Demographics
NPI:1427120005
Name:BECKHAM, AMY E (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464016 STATE ROAD 200
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6339
Mailing Address - Country:US
Mailing Address - Phone:904-261-4425
Mailing Address - Fax:904-261-8330
Practice Address - Street 1:464016 STATE ROAD 200
Practice Address - Street 2:VISION CENTER
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6339
Practice Address - Country:US
Practice Address - Phone:904-261-4425
Practice Address - Fax:904-261-8330
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3682152W00000X
GAOPT001941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU97955Medicare UPIN
FLK5032Medicare ID - Type Unspecified