Provider Demographics
NPI:1487664843
Name:HARE, RACHELLE LEA (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:LEA
Last Name:HARE
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 1:571 N LYNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1284
Mailing Address - Country:US
Mailing Address - Phone:417-732-9228
Mailing Address - Fax:417-732-5069
Practice Address - Street 1:1150 US HIGHWAY 60 E
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1580
Practice Address - Country:US
Practice Address - Phone:417-732-1706
Practice Address - Fax:417-732-2765
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist