Provider Demographics
NPI:1962630277
Name:SMITH, REBEKAH ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ANNE
Other - Last Name:VENEZIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:15037 MADEIRA WAY
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708
Mailing Address - Country:US
Mailing Address - Phone:727-800-4411
Mailing Address - Fax:727-491-5075
Practice Address - Street 1:15037 MADEIRA WAY
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708
Practice Address - Country:US
Practice Address - Phone:727-800-4411
Practice Address - Fax:727-491-5075
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist