MEDICARE: DR. STEVEN T RAE 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	AR2441	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770586521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN T RAE OD

Provider Business Mailing Address
First Line	:	PO BOX 444
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72654-0444
Country	:	US
Telephone Number	:	870-424-4900
Fax Number	:	870-741-6331

Provider Business Practice Location Address
First Line	:	105 SAWGRASS PT
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-3072
Country	:	US
Telephone Number	:	870-741-1910
Fax Number	:	870-741-6331

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/20/2021

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