MEDICARE: DR. ROBYN SUE RAKOV 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	152WV0400X	Vision Therapy Optometrist	6535T	CA

General Provider Information

NPI Number	:	1083758957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBYN SUE RAKOV OD

Provider Business Mailing Address
First Line	:	25301 CABOT ROAD
Second Line	:	SUITE NUMBER 112
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5511
Country	:	US
Telephone Number	:	949-768-7225
Fax Number	:	949-768-7514

Provider Business Practice Location Address
First Line	:	25301 CABOT ROAD
Second Line	:	SUITE NUMBER 112
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5511
Country	:	US
Telephone Number	:	949-768-7225
Fax Number	:	949-768-7514

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	03/30/2010

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