Provider Demographics
NPI:1083702898
Name:MCPHERSON, REBECCA N (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:MCPHERSON
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 1:3439 VERPLANK RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-9643
Mailing Address - Country:US
Mailing Address - Phone:315-695-2451
Mailing Address - Fax:
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2324
Practice Address - Country:US
Practice Address - Phone:315-458-1000
Practice Address - Fax:315-458-1001
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9391Medicare PIN
NYU32392Medicare UPIN
NY5922320001Medicare NSC