Healthcare Provider Details

I. General information

NPI: 1629467410
Provider Name (Legal Business Name): RACHEL ROTHSTEIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

800 MEMORIAL DR STE A
DANVILLE VA
24541-1680
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax:
Mailing address:
  • Phone: 434-799-3232
  • Fax: 434-792-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6314
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: