Provider Demographics
NPI:1477556736
Name:REICHLE, RANDALL N (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:N
Last Name:REICHLE
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 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE 650
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-797-1010
Mailing Address - Fax:713-357-7276
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE 650
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:713-797-1010
Practice Address - Fax:713-357-7276
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2355TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121641805Medicaid
TX121641806Medicaid
TX00605PMedicare PIN
TX8F1221Medicare ID - Type Unspecified
TX121641806Medicaid