Healthcare Provider Details

I. General information

NPI: 1790606903
Provider Name (Legal Business Name): RACHAEL ELIZABETH TEVIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 125TH ST
NEW YORK NY
10027-4410
US

IV. Provider business mailing address

227 WYCKOFF AVE APT 2R
BROOKLYN NY
11237-5306
US

V. Phone/Fax

Practice location:
  • Phone: 212-665-5051
  • Fax:
Mailing address:
  • Phone: 828-429-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: