Provider Demographics
NPI:1669432241
Name:RUDOLFER, REBECCA DELMORAL (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DELMORAL
Last Name:RUDOLFER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DEL MORAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2213 GREYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-6004
Mailing Address - Country:US
Mailing Address - Phone:850-322-1505
Mailing Address - Fax:850-792-4512
Practice Address - Street 1:2506 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4026
Practice Address - Country:US
Practice Address - Phone:850-792-4512
Practice Address - Fax:850-792-6019
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1669432241152W00000X
FLOPC 3197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620496100Medicaid
FL20822Medicare ID - Type Unspecified
FL620496100Medicaid