Provider Demographics
NPI:1245527423
Name:GAMBS, REBECCA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:GAMBS
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 1:70 N LISBON ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1326
Mailing Address - Country:US
Mailing Address - Phone:330-627-2430
Mailing Address - Fax:
Practice Address - Street 1:217 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2611
Practice Address - Country:US
Practice Address - Phone:330-343-8863
Practice Address - Fax:330-343-3590
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6039/T2954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052826Medicaid
OHH013210Medicare PIN