Provider Demographics
NPI:1821307844
Name:KENYON, RACHAEL NICOL (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:NICOL
Last Name:KENYON
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 1:5317 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6447
Mailing Address - Country:US
Mailing Address - Phone:503-648-5522
Mailing Address - Fax:503-844-9334
Practice Address - Street 1:5317 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-6447
Practice Address - Country:US
Practice Address - Phone:503-648-5522
Practice Address - Fax:503-844-9334
Is Sole Proprietor?:No
Enumeration Date:2010-09-26
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3359ATI152W00000X
WAOD 60160108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist