Provider Demographics
NPI:1629482617
Name:VICK, RACHEL MILLER (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MILLER
Last Name:VICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3001 RALEIGH RD W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8213
Mailing Address - Country:US
Mailing Address - Phone:919-934-8251
Mailing Address - Fax:919-934-8154
Practice Address - Street 1:1201 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4229
Practice Address - Country:US
Practice Address - Phone:919-934-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3169152W00000X
NC2389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCN133AMedicare PIN