Provider Demographics
NPI:1821284613
Name:SMITH, RACHAEL MARTHA (OD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARTHA
Last Name:SMITH
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 1:6822 N 55TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-3308
Mailing Address - Country:US
Mailing Address - Phone:623-293-1752
Mailing Address - Fax:
Practice Address - Street 1:7780 W ARROWHEAD TOWNE CTR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8612
Practice Address - Country:US
Practice Address - Phone:623-978-7628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1286AZ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist