Provider Demographics
NPI:1760051254
Name:BRAUNSDORF, REBECCA LAUREN LEPOVSKY (OD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LAUREN LEPOVSKY
Last Name:BRAUNSDORF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1916
Mailing Address - Country:US
Mailing Address - Phone:570-654-0880
Mailing Address - Fax:570-655-9857
Practice Address - Street 1:42 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1916
Practice Address - Country:US
Practice Address - Phone:570-654-0880
Practice Address - Fax:570-655-9857
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist