=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164688602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA ANN OLDING O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2008
-----------------------------------------------------
Last Update Date | 08/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1213 N MEMORIAL DR
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-654-9909
-----------------------------------------------------
Fax | 740-654-9969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7113 CROFT FARM DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43235-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-447-5045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 5800
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------