Provider Demographics
NPI:1083391890
Name:MACDOW, REBECCA (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MACDOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2630
Mailing Address - Country:US
Mailing Address - Phone:541-757-8844
Mailing Address - Fax:541-754-9810
Practice Address - Street 1:1597 SW 53RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2630
Practice Address - Country:US
Practice Address - Phone:541-757-8844
Practice Address - Fax:541-754-9810
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist