MEDICARE: DR. REBECCA J LAUFFENBURGER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WP0200X	Pediatric Optometrist	5487	OH

General Provider Information

NPI Number	:	1881698694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA J LAUFFENBURGER O.D.

Provider Business Mailing Address
First Line	:	961 DOVER RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-4105
Country	:	US
Telephone Number	:	330-262-0028
Fax Number	:	330-262-2808

Provider Business Practice Location Address
First Line	:	961 DOVER RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-4105
Country	:	US
Telephone Number	:	330-262-0028
Fax Number	:	330-262-2808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/09/2010

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