Provider Demographics
NPI:1497196059
Name:RAK, ASHLEY (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RAK
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 1:4372 WREN CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:WI
Mailing Address - Zip Code:53598-9806
Mailing Address - Country:US
Mailing Address - Phone:608-617-8812
Mailing Address - Fax:
Practice Address - Street 1:1009 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3560
Practice Address - Country:US
Practice Address - Phone:518-489-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3301-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist