Provider Demographics
NPI:1285657031
Name:RECK, STEPHEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:RECK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:345 COLLEGE ST SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1013
Mailing Address - Country:US
Mailing Address - Phone:360-456-3200
Mailing Address - Fax:360-456-3894
Practice Address - Street 1:345 COLLEGE ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1013
Practice Address - Country:US
Practice Address - Phone:360-456-3200
Practice Address - Fax:360-456-3894
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-10-07
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Provider Licenses
StateLicense IDTaxonomies
WA49408207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8508376Medicaid
WAG8874294Medicare PIN