Provider Demographics
NPI:1164825428
Name:BATES, RACHEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:BATES
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 1:513 BEACON ST
Mailing Address - Street 2:APT 10
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2309
Mailing Address - Country:US
Mailing Address - Phone:508-620-0017
Mailing Address - Fax:
Practice Address - Street 1:513 BEACON ST
Practice Address - Street 2:APT 10
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2309
Practice Address - Country:US
Practice Address - Phone:508-620-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist