Provider Demographics
NPI:1235297284
Name:NG, REBECCA L (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:NG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-489-2218
Mailing Address - Fax:949-496-3604
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-489-2218
Practice Address - Fax:949-496-3604
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410015394OtherRAILROAD MEDICARE
CASD0051890Medicaid
410015394OtherRAILROAD MEDICARE
T69990Medicare UPIN