Provider Demographics
NPI:1386843456
Name:HUISKEN, REBECCA A (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HUISKEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:SCHULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1715 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3751
Mailing Address - Country:US
Mailing Address - Phone:507-354-8531
Mailing Address - Fax:
Practice Address - Street 1:1715 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3751
Practice Address - Country:US
Practice Address - Phone:507-354-8531
Practice Address - Fax:507-359-1124
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN139787OtherUCARE
MN1386843456OtherMEDICA
MN6I476CHOtherBLUE CROSS BLUE SHIELD
MN930521052557OtherPREFERRED ONE
MN467693000Medicaid
MNHP84385OtherHEALTHPARTNERS
MN930521052557OtherPREFERRED ONE
MNP00480862Medicare PIN