Provider Demographics
NPI:1073701215
Name:TISCHINSKI, RACHEL R (OD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:TISCHINSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:R
Other - Last Name:ELVAMBUENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:211 NE 54TH STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4337
Mailing Address - Country:US
Mailing Address - Phone:816-455-2020
Mailing Address - Fax:816-459-5690
Practice Address - Street 1:211 NE 54TH STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4337
Practice Address - Country:US
Practice Address - Phone:816-455-2020
Practice Address - Fax:816-459-5690
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002019562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM77000002Medicare Oscar/Certification
MOU96646Medicare UPIN