Provider Demographics
NPI:1376537472
Name:WARTMAN, REBECCA HENSLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:HENSLEY
Last Name:WARTMAN
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 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2420
Mailing Address - Fax:502-996-8282
Practice Address - Street 1:51 GASH FARM RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2709
Practice Address - Country:US
Practice Address - Phone:800-843-7752
Practice Address - Fax:502-254-4069
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909963Medicaid
NC09963OtherBCBS PROV #
NCT65123Medicare UPIN
NC246615TMedicare PIN
NC7909963Medicaid
NC246615RMedicare ID - Type UnspecifiedMEDICARE ID