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NPI Code Detail

MEDICARE: SAMANTHA RAU OD

MEDICARE:   SAMANTHA  RAU  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
1152W00000XOptometrist2024019848MO

General Provider Information

NPI Number : 1295576874
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA RAU OD
Provider Business Mailing Address
First Line : 7218 NIEMAN RD
Second Line :
City : SHAWNEE
State : KS
Zip : 66203-4460
Country : US
Telephone Number : 316-712-1647
Fax Number :
Provider Business Practice Location Address
First Line : 11010 HASKELL AVE
Second Line :
City : KANSAS CITY
State : KS
Zip : 66109-8500
Country : US
Telephone Number : 816-478-1230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2024
Last Update Date : 06/05/2024

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