Provider Demographics
NPI:1942224324
Name:MOSER, REBECCA ERIN (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ERIN
Last Name:MOSER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:ERIN
Other - Last Name:HUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2783 N SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6983
Mailing Address - Country:US
Mailing Address - Phone:479-442-8865
Mailing Address - Fax:479-442-2678
Practice Address - Street 1:3318 N. NORTH HILLS BLVD
Practice Address - Street 2:MCDONALD EYE SERVICES P.A
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-521-2555
Practice Address - Fax:479-521-6761
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6904T152W00000X
AR2695152W00000X
LA1531-661T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182427801Medicaid
LA2317423Medicaid
V10248OtherUPIN
TX8G7926Medicare PIN
TX182427801Medicaid