Provider Demographics
NPI:1548961428
Name:MAURER, REBECCA LYNN (LICENSED DISPENSING)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:MAURER
Suffix:
Gender:F
Credentials:LICENSED DISPENSING
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED DISPENSING
Mailing Address - Street 1:1448 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069
Mailing Address - Country:US
Mailing Address - Phone:413-283-2946
Mailing Address - Fax:413-283-3631
Practice Address - Street 1:1448 NORTH MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069
Practice Address - Country:US
Practice Address - Phone:413-283-2946
Practice Address - Fax:413-283-3631
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6088156FC0801X, 156FX1800X
156FX1100X, 156FX1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician