Provider Demographics
NPI:1184676017
Name:PAYNE, REBECCA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:PASCAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1231 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1484
Mailing Address - Country:US
Mailing Address - Phone:231-924-2700
Mailing Address - Fax:231-924-9255
Practice Address - Street 1:1231 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1484
Practice Address - Country:US
Practice Address - Phone:231-924-2700
Practice Address - Fax:231-924-9255
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
383628290OtherTAX ID
MI94-4316560Medicaid
MI0F21032OtherBCN
MI900F210320OtherBCBS
MI1262670001Medicare NSC
MIP34990001Medicare PIN
MI900F210320OtherBCBS
383628290OtherTAX ID