Provider Demographics
NPI:1134502396
Name:MARZOUCA, REBECCA (OD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MARZOUCA
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 1:6703 NW 7TH ST
Mailing Address - Street 2:KIN 342
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6056
Mailing Address - Country:US
Mailing Address - Phone:860-997-2573
Mailing Address - Fax:
Practice Address - Street 1:1541 W NEW HAVEN AVE
Practice Address - Street 2:SHOP # 5335
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3905
Practice Address - Country:US
Practice Address - Phone:800-571-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist