Provider Demographics
NPI:1851521041
Name:HARRIS, REBECCA SCHLETER (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SCHLETER
Last Name:HARRIS
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 1:125 COLLIN DR
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1168
Mailing Address - Country:US
Mailing Address - Phone:859-734-2020
Mailing Address - Fax:859-734-3695
Practice Address - Street 1:125 COLLIN DR
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1168
Practice Address - Country:US
Practice Address - Phone:859-734-2020
Practice Address - Fax:859-734-3695
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1787DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142760Medicaid
KYP400028173Medicare PIN