Provider Demographics
NPI:1235161035
Name:TODD, REBEKAH ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:ELIZABETH
Last Name:TODD
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 1:2250 N POINTE DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-9042
Mailing Address - Country:US
Mailing Address - Phone:574-267-3515
Mailing Address - Fax:574-267-3259
Practice Address - Street 1:2250 N POINTE DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-9042
Practice Address - Country:US
Practice Address - Phone:574-267-3515
Practice Address - Fax:574-267-3259
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009867152W00000X
KY1800DT152W00000X
IN18003626A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200989490Medicaid
KY7100125250Medicaid
IN000000672073OtherBCBS
000000672073OtherBCBS
ILMT1469279OtherDEA
IN200989490Medicaid
ILK31137Medicare PIN
KY7100125250Medicaid
ILV10313Medicare UPIN
IN5419240009Medicare NSC
INM400021449Medicare PIN
KY5419240010Medicare NSC