Healthcare Provider Details

I. General information

NPI: 1346968401
Provider Name (Legal Business Name): RACHEL MARIE OBRIEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9617 GULF RESEARCH LN
FORT MYERS FL
33912-4555
US

IV. Provider business mailing address

9617 GULF RESEARCH LN
FORT MYERS FL
33912-4555
US

V. Phone/Fax

Practice location:
  • Phone: 239-418-0999
  • Fax: 239-418-0091
Mailing address:
  • Phone: 239-418-0999
  • Fax: 239-418-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: