Healthcare Provider Details

I. General information

NPI: 1164688602
Provider Name (Legal Business Name): REBECCA ANN OLDING O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 N MEMORIAL DR
LANCASTER OH
43130-1626
US

IV. Provider business mailing address

7113 CROFT FARM DR
COLUMBUS OH
43235-5741
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-9909
  • Fax: 740-654-9969
Mailing address:
  • Phone: 330-447-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5800
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: