Provider Demographics
NPI:1962470864
Name:MUSICK, REBECCA KAE (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAE
Last Name:MUSICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KAE
Other - Last Name:MIKOLAJCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16331 HERITAGE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7753
Mailing Address - Country:US
Mailing Address - Phone:907-694-2511
Mailing Address - Fax:907-694-3900
Practice Address - Street 1:16331 HERITAGE PL STE 104
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7753
Practice Address - Country:US
Practice Address - Phone:907-694-2511
Practice Address - Fax:907-694-3900
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3061152W00000X
AK130799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410028715OtherTRAVELERS MEDICARE RETIRE
58527503OtherAETNA
032340000OtherCIGNA
100457OtherDEPT OF LABOR AND INDUSTR
410028715OtherUPPR
610605300OtherDEPT OF LABOR SEATTLE DFE
WA2017747Medicaid
U44759OtherVISION SERVICE PLAN
25766226OtherGROUP HEALTH
8886644808OtherCOMM HEALTH PLAN OF WASH
022886004OtherREGENCE OREGON
8886644808OtherCOMM HEALTH PLAN OF WASH
MU6254OtherREGENCE WASHINGTON
U44759Medicare UPIN
610605300OtherDEPT OF LABOR SEATTLE DFE