Provider Demographics
NPI:1902370133
Name:HYACINTHE, REBEKAH BRIE (RDO, NCLE)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:BRIE
Last Name:HYACINTHE
Suffix:
Gender:F
Credentials:RDO, NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ENON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1168
Mailing Address - Country:US
Mailing Address - Phone:978-922-5996
Mailing Address - Fax:978-922-5997
Practice Address - Street 1:40 ENON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1168
Practice Address - Country:US
Practice Address - Phone:978-922-5996
Practice Address - Fax:978-922-5997
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6656156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician