Provider Demographics
NPI:1407548548
Name:REBECCA J COLBURN
Entity Type:Organization
Organization Name:REBECCA J COLBURN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-724-7641
Mailing Address - Street 1:10260 JORDAN RIVER DR SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9189
Mailing Address - Country:US
Mailing Address - Phone:616-724-7641
Mailing Address - Fax:
Practice Address - Street 1:5859 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6905
Practice Address - Country:US
Practice Address - Phone:616-949-5125
Practice Address - Fax:616-949-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty