Provider Demographics
NPI:1053608356
Name:REBUCK & ASSOCIATES EYE CARE PLLC
Entity type:Organization
Organization Name:REBUCK & ASSOCIATES EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:REBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-263-4747
Mailing Address - Street 1:255 APPALOOSA DR
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-3854
Mailing Address - Country:US
Mailing Address - Phone:304-263-4747
Mailing Address - Fax:304-263-4747
Practice Address - Street 1:801 N MILDRED ST
Practice Address - Street 2:UNIT 1B
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1690
Practice Address - Country:US
Practice Address - Phone:304-263-4747
Practice Address - Fax:304-263-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty