Provider Demographics
NPI:1760104749
Name:KANE, RACHEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:KANE
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 1:185 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-8954
Mailing Address - Country:US
Mailing Address - Phone:662-614-1341
Mailing Address - Fax:
Practice Address - Street 1:8200 WHITESBURG DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3006
Practice Address - Country:US
Practice Address - Phone:256-880-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN3756152W00000X
ALR-334-TA-D05152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist