=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528082567
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY ALAN RAHN O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 02/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5854 CINEMA DR
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45150-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-248-1212
-----------------------------------------------------
Fax | 513-248-1247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5854 CINEMA DR
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45150-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-248-1212
-----------------------------------------------------
Fax | 513-248-1247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3304/T1188
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------