Healthcare Provider Details

I. General information

NPI: 1669524757
Provider Name (Legal Business Name): REBECCA CORINNE VOORTHUIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW
WASHINGTON DC
20016-3622
US

IV. Provider business mailing address

3301 NEW MEXICO AVE NW
WASHINGTON DC
20016-3622
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-5087
  • Fax: 202-363-5063
Mailing address:
  • Phone: 202-363-5087
  • Fax: 202-363-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP 826
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA 1613
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number06018000927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: