Healthcare Provider Details

I. General information

NPI: 1700522406
Provider Name (Legal Business Name): RACHEL ESCOBIO ROCHE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ESCOBIO

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 LAKELAND HILLS BLVD
LAKELAND FL
33805-4673
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-2260
  • Fax:
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: