Provider Demographics
NPI:1740285659
Name:MATCHOK, REBECCA R (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:R
Last Name:MATCHOK
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:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34220-0434
Mailing Address - Country:US
Mailing Address - Phone:941-761-7373
Mailing Address - Fax:
Practice Address - Street 1:5315 CORTEZ RD W
Practice Address - Street 2:VISION CENTER
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2814
Practice Address - Country:US
Practice Address - Phone:941-761-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20735AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL593516415OtherTAX IDENTIFICATION
FLU63361Medicare UPIN
FL410041263OtherRAILROAD MEDICARE