Provider Demographics
NPI:1043282106
Name:KABAT, REBECCA ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANNE
Last Name:KABAT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4499
Mailing Address - Country:US
Mailing Address - Phone:715-832-4946
Mailing Address - Fax:715-832-0699
Practice Address - Street 1:2600 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4499
Practice Address - Country:US
Practice Address - Phone:715-832-4946
Practice Address - Fax:715-832-0699
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30350355152W00000X
WI3035-035152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38627800Medicaid
V06652Medicare UPIN
WI001047245Medicare PIN