Provider Demographics
NPI:1255325478
Name:STREETER, RACHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:
Last Name:STREETER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:43309 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-6221
Mailing Address - Country:US
Mailing Address - Phone:727-943-3111
Mailing Address - Fax:727-943-3334
Practice Address - Street 1:43309 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-6221
Practice Address - Country:US
Practice Address - Phone:727-943-3111
Practice Address - Fax:727-943-3334
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6599535OtherGHI
FL20086OtherBCBS
FLU94231Medicare UPIN
FLU0303ZMedicare PIN