Basic Information
| Provider Information | |||||||||
| NPI: | 1487678157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUDISILL | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 LOUCKS RD | ||||||||
| Address2: | SUITE 653 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174084609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177648705 | ||||||||
| FaxNumber: | 7177675680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2553 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174022403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177575632 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG001237 | PA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 27162 | 01 | AVESIS | OTHER | PA1237 | 01 | PA | EYEMED | OTHER | PA97402 | 01 | VBA | OTHER | 06688006 | 01 | DAVIS VISION | OTHER | 1014782270002 | 05 | PA | MEDICAID | RU1518210 | 01 | PA | HIMARK BLUE SHIELD | OTHER |