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General NPI Number Information
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NPI Number | 1881121853
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Entity Type | Organization
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Legal Business Name | RAH OD
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 2013 MILWAUKEE AVE
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City | RIVERWOODS
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State | IL
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Zip | 60015-3581
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Country | US
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Telephone | 563-581-5298
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Fax |
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Provider Business Mailing Address
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Address Line | 209 S LANCELOT LN
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City | PALATINE
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State | IL
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Zip | 60074-6823
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Country | US
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Telephone | 563-581-5298
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | RACHEL HUTCHINS
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Credential | OD
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Telephone | 563-581-5298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 046010749
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License Number State | IL
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