Provider Demographics
NPI:1306989074
Name:FRANK, REBA JUNE (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:REBA
Middle Name:JUNE
Last Name:FRANK
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RICHMOND RD N STE F
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1015
Mailing Address - Country:US
Mailing Address - Phone:859-985-0044
Mailing Address - Fax:859-985-0045
Practice Address - Street 1:400 RICHMOND RD N STE F
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1015
Practice Address - Country:US
Practice Address - Phone:859-985-0044
Practice Address - Fax:859-985-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1075156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY52000130Medicaid
KYKY1075OtherEYEMED