Provider Demographics
NPI:1235114935
Name:RAJCHEL, DAVID RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:RAJCHEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W MARKET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1917
Mailing Address - Country:US
Mailing Address - Phone:570-622-8505
Mailing Address - Fax:570-622-9501
Practice Address - Street 1:2000 W MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1917
Practice Address - Country:US
Practice Address - Phone:570-622-8505
Practice Address - Fax:570-622-9501
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000856152WC0802X
PAOEG 000856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109033OtherHIGHMARK BLUE SHIELD
PA0548646OtherAETNA
PA21007OtherGEISINGER HEALTH PLAN
PA397020OtherNATIONAL VISION ADMINISTR
PAOEG 000856OtherVISION BENEFITS OF AMERIC
PA01564901OtherCAPITAL BLUE CROSS
PA01564901OtherCAPITAL BLUE CROSS
PA21007OtherGEISINGER HEALTH PLAN
PA1136600001Medicare NSC