Provider Demographics
NPI:1164072575
Name:REDMOND, REBECCA LEE (LDO)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LEE
Last Name:REDMOND
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1736
Mailing Address - Country:US
Mailing Address - Phone:931-842-0822
Mailing Address - Fax:
Practice Address - Street 1:40 CARROLL ST
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1736
Practice Address - Country:US
Practice Address - Phone:931-842-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2538156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty