Provider Demographics
NPI:1538473012
Name:WILLIAMS, REBECCA RUTH (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RUTH
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3801 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2905
Mailing Address - Country:US
Mailing Address - Phone:502-813-3341
Mailing Address - Fax:
Practice Address - Street 1:1705 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5506
Practice Address - Country:US
Practice Address - Phone:270-765-2020
Practice Address - Fax:502-736-4490
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1808DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist