Provider Demographics
NPI:1063837847
Name:RAKOTZ, RICK (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:RAKOTZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N DEVILS DEN RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AR
Mailing Address - Zip Code:72959-2605
Mailing Address - Country:US
Mailing Address - Phone:479-530-3825
Mailing Address - Fax:
Practice Address - Street 1:1400 N DEVILS DEN RD
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AR
Practice Address - Zip Code:72959-2605
Practice Address - Country:US
Practice Address - Phone:479-530-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-030453156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician