=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255103164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA ANN LITTLE LDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2023
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 WALMART DR
-----------------------------------------------------
City | EATONTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31024-6761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-816-9545
-----------------------------------------------------
Fax | 706-485-7934
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 WALMART DR
-----------------------------------------------------
City | EATONTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31024-6761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-816-9545
-----------------------------------------------------
Fax | 706-485-7934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | LDO002188
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------