MEDICARE: DR. JEFFREY LEE RAKOWSKY O.D.

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	1023	AZ

General Provider Information

NPI Number	:	1871669671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LEE RAKOWSKY O.D.

Provider Business Mailing Address
First Line	:	1517 W SEA HAZE DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-7023
Country	:	US
Telephone Number	:	480-221-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	4419 E. MAIN STREET
Second Line	:	SUITE 109
City	:	MESA
State	:	AZ
Zip	:	85205-7900
Country	:	US
Telephone Number	:	480-830-1292
Fax Number	:	480-924-9042

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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