Provider Demographics
NPI:1164806915
Name:KOSCHNICK, RACHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:
Last Name:KOSCHNICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 MICKELBERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8302
Mailing Address - Country:US
Mailing Address - Phone:360-301-3008
Mailing Address - Fax:
Practice Address - Street 1:10000 MICKELBERRY RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8302
Practice Address - Country:US
Practice Address - Phone:360-308-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60571980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist