MEDICARE: RACHEL DICKERT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2212	AZ

General Provider Information

NPI Number	:	1053838409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL DICKERT OD

Provider Business Mailing Address
First Line	:	220 N MCKEMY AVE
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2654
Country	:	US
Telephone Number	:	480-835-4472
Fax Number	:	480-893-8172

Provider Business Practice Location Address
First Line	:	6815 N 19TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1134
Country	:	US
Telephone Number	:	602-242-5293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	03/17/2018

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Directions to “ RACHEL DICKERT OD” Practice Location

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