Provider Demographics
NPI:1285252684
Name:WAKEFIELD, RACHEL MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARIE
Last Name:WAKEFIELD
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 1:585 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1807
Mailing Address - Country:US
Mailing Address - Phone:931-526-6711
Mailing Address - Fax:931-526-6712
Practice Address - Street 1:585 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1807
Practice Address - Country:US
Practice Address - Phone:931-526-6711
Practice Address - Fax:931-526-6712
Is Sole Proprietor?:No
Enumeration Date:2020-07-12
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist