Provider Demographics
NPI:1275683658
Name:MCMURDO, REBECCA JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JANE
Last Name:MCMURDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14243 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8100
Mailing Address - Country:US
Mailing Address - Phone:352-799-3935
Mailing Address - Fax:352-593-5933
Practice Address - Street 1:14243 POWELL RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-8100
Practice Address - Country:US
Practice Address - Phone:352-799-3935
Practice Address - Fax:352-593-5933
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU93048Medicare UPIN
FLE8734ZMedicare ID - Type Unspecified