Provider Demographics
NPI:1821290792
Name:VERNA, REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:VERNA
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 1:3300 GRANT AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2632
Mailing Address - Country:US
Mailing Address - Phone:215-335-9090
Mailing Address - Fax:215-333-5225
Practice Address - Street 1:3300 GRANT AVE STE 21
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2632
Practice Address - Country:US
Practice Address - Phone:215-335-9090
Practice Address - Fax:215-333-5225
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000070152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3533797000OtherKEYSTONE HEALTH PLAN EAST
PA3533797000OtherPERSONAL CHOICE BLUE SHIELD
PA102306414Medicaid
PA102306414Medicaid