Provider Demographics
NPI:1346449063
Name:WHITE, RACHAEL RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RACHAEL
Other - Middle Name:RENEE
Other - Last Name:PRENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4244 INDIAN RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3279
Mailing Address - Country:US
Mailing Address - Phone:937-320-0300
Mailing Address - Fax:937-320-0500
Practice Address - Street 1:4244 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3279
Practice Address - Country:US
Practice Address - Phone:937-320-0300
Practice Address - Fax:937-320-0500
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWH4218012Medicare PIN