Healthcare Provider Details

I. General information

NPI: 1740448752
Provider Name (Legal Business Name): REBEKAH SUE NOSS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MUNSON AVE
TRAVERSE CITY MI
49686-3096
US

IV. Provider business mailing address

328 MUNSON AVE STE A
TRAVERSE CITY MI
49686-3097
US

V. Phone/Fax

Practice location:
  • Phone: 231-946-8460
  • Fax:
Mailing address:
  • Phone: 231-946-8460
  • Fax: 231-946-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: