Provider Demographics
NPI:1265057202
Name:SANDERS, REBEKAH LEIGH (OD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEIGH
Last Name:SANDERS
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 1:1000 W STATE HIGHWAY 6 STE 210
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3788
Mailing Address - Country:US
Mailing Address - Phone:254-776-8119
Mailing Address - Fax:
Practice Address - Street 1:1000 W STATE HIGHWAY 6 STE 210
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3788
Practice Address - Country:US
Practice Address - Phone:254-776-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty