Provider Demographics
NPI:1275759003
Name:FAIRCHILD, VICTORIA ANN RAHME (OD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN RAHME
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:RAHME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3338 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3512
Mailing Address - Country:US
Mailing Address - Phone:918-743-9918
Mailing Address - Fax:918-743-9919
Practice Address - Street 1:3338 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3512
Practice Address - Country:US
Practice Address - Phone:918-743-9918
Practice Address - Fax:918-743-9919
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2348152W00000X
KSKS1582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPTQ27621OtherSPECTERA
OK100765750AMedicaid
OK900522295OtherMEDICARE GROUP ID
OK2348OtherEYE MED
OK5621750001OtherDMERC
OK900522295OtherMEDICARE GROUP ID
OK100765750AMedicaid
OK249529802Medicare PIN
OK5621750001Medicare NSC