Provider Demographics
NPI:1073593133
Name:RACHFORD, JAMES MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:RACHFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57463 29 PALMS HWY
Mailing Address - Street 2:SUITE #201
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2925
Mailing Address - Country:US
Mailing Address - Phone:760-365-2020
Mailing Address - Fax:760-228-0864
Practice Address - Street 1:57463 29 PALMS HWY
Practice Address - Street 2:SUITE #201
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2925
Practice Address - Country:US
Practice Address - Phone:760-365-2020
Practice Address - Fax:760-228-0864
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7037T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992714OtherPIN
0SD0070370Medicare ID - Type Unspecified
CA0172250001Medicare NSC
T10458Medicare UPIN