Provider Demographics
NPI:1750477360
Name:KITCHENS, REBECCA L (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:KITCHENS
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 1:4141 NE STEPHENS ST # 97475
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1161
Mailing Address - Country:US
Mailing Address - Phone:541-378-0033
Mailing Address - Fax:
Practice Address - Street 1:4141 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1161
Practice Address - Country:US
Practice Address - Phone:541-378-0033
Practice Address - Fax:541-378-0034
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist