Provider Demographics
NPI:1114589132
Name:HIXSON, RACHAEL NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:NICOLE
Last Name:HIXSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S GASTON ST APT 12
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-2858
Mailing Address - Country:US
Mailing Address - Phone:904-504-3615
Mailing Address - Fax:
Practice Address - Street 1:101 SIMPSON ST
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-2231
Practice Address - Country:US
Practice Address - Phone:903-843-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9732T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist