Provider Demographics
NPI:1225080559
Name:GARRETT, RACHAEL LYNN (OD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN
Last Name:GARRETT
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 1:2241 LLOYD CTR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1315
Mailing Address - Country:US
Mailing Address - Phone:503-494-6107
Mailing Address - Fax:503-494-0470
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-7672
Practice Address - Fax:503-418-0049
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2713ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00845504OtherRAILROAD MEDICARE
OR294170Medicaid
P00845504OtherRAILROAD MEDICARE
R152265Medicare PIN