Provider Demographics
NPI:1841282522
Name:WOODRING, REBECCA L (OD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:WOODRING
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 1:736 WINTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3950
Mailing Address - Country:US
Mailing Address - Phone:724-772-2202
Mailing Address - Fax:
Practice Address - Street 1:187 SCHARBERRY LANE
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-7864
Practice Address - Country:US
Practice Address - Phone:724-591-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU77413Medicare UPIN
PA083606EBKMedicare ID - Type Unspecified