Provider Demographics
NPI:1376559567
Name:RECHICHAR, MONICA LYN (OD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LYN
Last Name:RECHICHAR
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 1:188 E MILLSBORO RD
Mailing Address - Street 2:
Mailing Address - City:EAST MILLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:15433-1144
Mailing Address - Country:US
Mailing Address - Phone:724-984-6914
Mailing Address - Fax:
Practice Address - Street 1:111 THORNTON RD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-9607
Practice Address - Country:US
Practice Address - Phone:724-785-5656
Practice Address - Fax:247-856-0627
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01972907Medicaid
PA074426Medicare ID - Type UnspecifiedINDIVIDUAL
PAU97315Medicare UPIN