Provider Demographics
NPI:1407479918
Name:ANDERSON, REBECCA VELASCO (OD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:VELASCO
Last Name:ANDERSON
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26615 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8347
Mailing Address - Country:US
Mailing Address - Phone:425-413-8787
Mailing Address - Fax:425-413-4012
Practice Address - Street 1:26615 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8347
Practice Address - Country:US
Practice Address - Phone:425-413-8787
Practice Address - Fax:425-413-4012
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist