Provider Demographics
NPI:1811369044
Name:KIVLIN, REBECCA LYNNE (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:KIVLIN
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 1:3031 JAVIER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4638
Mailing Address - Country:US
Mailing Address - Phone:703-698-8880
Mailing Address - Fax:703-698-8884
Practice Address - Street 1:3031 JAVIER RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4638
Practice Address - Country:US
Practice Address - Phone:703-698-8880
Practice Address - Fax:703-698-8884
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002728152W00000X
CT2963152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist