MEDICARE: RACHEL EMILY BRELIANT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	RESIDENT	IL
2	152W00000X	Optometrist	011262	NY

General Provider Information

NPI Number	:	1457195539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL EMILY BRELIANT OD

Provider Business Mailing Address
First Line	:	820 S DAMEN AVE APT 552
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3728
Country	:	US
Telephone Number	:	312-569-8387
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE STE 1J
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1263
Country	:	US
Telephone Number	:	718-741-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	08/07/2025

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