Provider Demographics
NPI:1427211416
Name:BURNETT, RACHEL LYNNET (OD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNNET
Last Name:BURNETT
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 1:1506 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3919
Mailing Address - Country:US
Mailing Address - Phone:903-758-8832
Mailing Address - Fax:903-238-8876
Practice Address - Street 1:1506 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3919
Practice Address - Country:US
Practice Address - Phone:903-758-8832
Practice Address - Fax:903-238-8876
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7232TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7232TGOtherTEXAS OPTOMETRY BOARD
TX85712QOtherBLUECROSS BLUESHIELD
TX00157KMedicare PIN