Provider Demographics
NPI:1407004724
Name:PAIK, RAECHELLE E (OD)
Entity Type:Individual
Prefix:
First Name:RAECHELLE
Middle Name:E
Last Name:PAIK
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 1:1101 W JACKSON BLVD
Mailing Address - Street 2:OPTICAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2905
Mailing Address - Country:US
Mailing Address - Phone:877-734-3844
Mailing Address - Fax:
Practice Address - Street 1:1101 W JACKSON BLVD
Practice Address - Street 2:OPTICAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2905
Practice Address - Country:US
Practice Address - Phone:877-734-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist