Provider Demographics
NPI:1508962390
Name:HUTCHINS, REBECCA ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELAINE
Last Name:HUTCHINS
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 1:6800 N 79TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7042
Mailing Address - Country:US
Mailing Address - Phone:303-652-0505
Mailing Address - Fax:303-652-0606
Practice Address - Street 1:6800 N 79TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7042
Practice Address - Country:US
Practice Address - Phone:303-652-0505
Practice Address - Fax:303-652-0606
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1254152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1366505Medicare UPIN