Provider Demographics
NPI:1851372445
Name:MORFORD, REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:MORFORD
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 1:190 BEACON RD
Mailing Address - Street 2:
Mailing Address - City:RENFREW
Mailing Address - State:PA
Mailing Address - Zip Code:16053-1206
Mailing Address - Country:US
Mailing Address - Phone:724-822-6179
Mailing Address - Fax:
Practice Address - Street 1:101 CLEARVIEW CIR
Practice Address - Street 2:BOSCOV'S OPTICAL
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1576
Practice Address - Country:US
Practice Address - Phone:724-285-2139
Practice Address - Fax:724-283-2084
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03831-001OtherDAVIS VISION
PA205052/102386OtherEYEMED/ COLE
PA656619OtherBC/BS INDIVIDUAL
PA2529139OtherAETNA INDIVIDUAL
PA106109OtherBC/BS GROUP
PA396975OtherNVA GROUP
PA01611137OtherGATEWAY
PA2077435OtherAETNA GROUP
PA0017950990002Medicaid
PA2518269522A12OtherANTHEM PIN
PA0016689/ 014829OtherDORAL VISION
PA2518269522A00OtherANTHEM GROUP
PA2518269522A00OtherANTHEM GROUP
PA2518269522A12OtherANTHEM PIN