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General NPI Number Information
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NPI Number | 1679690754
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Entity Type | Organization
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Legal Business Name | DR. RICHARD C. REBUCK, OD
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 800 FOXCROFT AVE STE 914
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City | MARTINSBURG
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State | WV
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Zip | 25401-1829
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Country | US
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Telephone | 304-263-4747
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Fax | 304-263-2935
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Provider Business Mailing Address
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Address Line | 255 APPALOOSA DR
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City | FALLING WATERS
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State | WV
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Zip | 25419-3854
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Country | US
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Telephone | 304-263-4747
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Fax | 304-263-2935
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD CARL REBUCK
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Credential | O.D.
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Telephone | 304-263-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 971-OD
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License Number State | WV
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