Provider Demographics
NPI:1407875347
Name:NALLY, REBECCA A (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:NALLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 659
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3937
Mailing Address - Fax:585-276-0236
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 659
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-3937
Practice Address - Fax:585-276-0236
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY006576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA1682Medicare ID - Type Unspecified