Provider Demographics
NPI:1043279573
Name:KAHAN, RACHEL (OD)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:KAHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:EIDLISZ-KAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:934 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3102
Mailing Address - Country:US
Mailing Address - Phone:718-758-1903
Mailing Address - Fax:718-758-1903
Practice Address - Street 1:934 E 18TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3102
Practice Address - Country:US
Practice Address - Phone:718-758-1903
Practice Address - Fax:718-758-1903
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005842-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40934OtherDAVISVISION
NY0120026701OtherAMERICHOICE
NY02144067Medicaid
NY215800101OtherHEALTHPLUS
NYVUT005842OtherHIP HEALTH PLAN
NYP128136OtherOXFORD
NY40934OtherDAVISVISION
NYU79344Medicare UPIN