Provider Demographics
NPI:1740515436
Name:REBENITSCH, RONALD LUKE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LUKE
Last Name:REBENITSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 NE 3RD ST APT 204
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4080
Mailing Address - Country:US
Mailing Address - Phone:701-471-0796
Mailing Address - Fax:
Practice Address - Street 1:7101 NW EXPRESSWAY
Practice Address - Street 2:SUITE 335
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1579
Practice Address - Country:US
Practice Address - Phone:405-733-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPT 13527207W00000X
KS04-36398207W00000X
OK31188207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology