Healthcare Provider Details

I. General information

NPI: 1306989074
Provider Name (Legal Business Name): REBA JUNE FRANK OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RICHMOND RD N STE F
BEREA KY
40403-1015
US

IV. Provider business mailing address

400 RICHMOND RD N STE F
BEREA KY
40403-1015
US

V. Phone/Fax

Practice location:
  • Phone: 859-985-0044
  • Fax: 859-985-0045
Mailing address:
  • Phone: 859-985-0044
  • Fax: 859-985-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1075
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: