Provider Demographics
NPI:1255051322
Name:KLEIN, REBEKAH RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:RENEE
Last Name:KLEIN
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 1:18232 CUMMINGS ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3005
Mailing Address - Country:US
Mailing Address - Phone:909-292-8002
Mailing Address - Fax:
Practice Address - Street 1:1280 S VICTORIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6550
Practice Address - Country:US
Practice Address - Phone:805-650-9922
Practice Address - Fax:805-650-6656
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35229152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist