Healthcare Provider Details

I. General information

NPI: 1871806372
Provider Name (Legal Business Name): MICHAEL REBARCHIK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W MARKET ST
GEORGETOWN DE
19947-2322
US

IV. Provider business mailing address

502 W MARKET ST
GEORGETOWN DE
19947-2322
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-2020
  • Fax: 302-856-4970
Mailing address:
  • Phone: 302-856-2020
  • Fax: 302-856-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberI30001352
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: