Provider Demographics
NPI:1558334870
Name:REBMAN, JOSEPH PAUL (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:REBMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:282 MAYTOWN ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9313
Mailing Address - Country:US
Mailing Address - Phone:717-367-8368
Mailing Address - Fax:717-367-6266
Practice Address - Street 1:282 MAYTOWN ROAD
Practice Address - Street 2:STE 100
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9313
Practice Address - Country:US
Practice Address - Phone:717-367-8368
Practice Address - Fax:717-367-6266
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02844900OtherBLUE CROSS NUMBER
PA0852204OtherAETNA US HEALTHCARE
PADD3234OtherRAILROAD
PAP00221443OtherRR MEDICARE
PADD3234OtherRAILROAD
PA058290Medicare PIN
PA02844900OtherBLUE CROSS NUMBER