Provider Demographics
NPI:1487678157
Name:RUDISILL, REBECCA L (OD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:RUDISILL
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 1:1800 LOUCKS RD
Mailing Address - Street 2:SUITE 653
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4609
Mailing Address - Country:US
Mailing Address - Phone:717-764-8705
Mailing Address - Fax:717-767-5680
Practice Address - Street 1:2553 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2403
Practice Address - Country:US
Practice Address - Phone:717-757-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
27162OtherAVESIS
PAPA1237OtherEYEMED
PA97402OtherVBA
06688006OtherDAVIS VISION
PA1014782270002Medicaid
PARU1518210OtherHIMARK BLUE SHIELD
PA1014782270002Medicaid
PARU1518210OtherHIMARK BLUE SHIELD