Provider Demographics
NPI:1174526479
Name:GATES, RACHEL (OD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:GATES
Other - Last Name:HOLLENBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 E BELTLINE AVE NE
Mailing Address - Street 2:STE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6046
Mailing Address - Country:US
Mailing Address - Phone:616-949-2600
Mailing Address - Fax:616-954-0213
Practice Address - Street 1:750 E BELTLINE AVE NE
Practice Address - Street 2:STE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6049
Practice Address - Country:US
Practice Address - Phone:616-588-6542
Practice Address - Fax:616-365-2076
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004106152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00192048OtherMEDICARE RR
MI4803926Medicaid
MI900D111550OtherBCBS
MI900D111550OtherBCBS
MI4803926Medicaid
MIP00192048OtherMEDICARE RR