Provider Demographics
NPI:1205498011
Name:HALES, REBECCA JANE (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JANE
Last Name:HALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11157 SEABISCUIT DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4955
Mailing Address - Country:US
Mailing Address - Phone:765-639-9936
Mailing Address - Fax:
Practice Address - Street 1:120 E STATE ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-1027
Practice Address - Country:US
Practice Address - Phone:765-778-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004163A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist