Provider Demographics
NPI:1285856682
Name:REBOUND INC OF VA.
Entity Type:Organization
Organization Name:REBOUND INC OF VA.
Other - Org Name:TRAYLOR OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FEBER
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED OPTICIAN
Authorized Official - Phone:757-625-0518
Mailing Address - Street 1:400 GRESHAM DR
Mailing Address - Street 2:MEDICAL TOWER ANNEX
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-625-0518
Mailing Address - Fax:757-313-5103
Practice Address - Street 1:400 GRESHAM DR
Practice Address - Street 2:MEDICAL TOWER ANNEX
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-625-0518
Practice Address - Fax:757-313-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA742332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0156210001Medicare ID - Type UnspecifiedRETAIL OPTICAL