Healthcare Provider Details

I. General information

NPI: 1770476343
Provider Name (Legal Business Name): RACHEL LOOTENS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 BAY AREA BLVD
HOUSTON TX
77058-2538
US

IV. Provider business mailing address

1409 MONARCH OAKS ST
HOUSTON TX
77055-3433
US

V. Phone/Fax

Practice location:
  • Phone: 281-488-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11402TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: