Healthcare Provider Details

I. General information

NPI: 1184676017
Provider Name (Legal Business Name): REBECCA LYNN PAYNE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. REBECCA LYNN PASCAVIS

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 W MAIN ST
FREMONT MI
49412-1484
US

IV. Provider business mailing address

1231 W MAIN ST
FREMONT MI
49412-1484
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-2700
  • Fax: 231-924-9255
Mailing address:
  • Phone: 231-924-2700
  • Fax: 231-924-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003937
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: