Provider Demographics
NPI:1497800437
Name:REISCHER, CHARLES HENRY (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HENRY
Last Name:REISCHER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 FLATBUSH AVE
Mailing Address - Street 2:STORE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4036
Mailing Address - Country:US
Mailing Address - Phone:718-622-1880
Mailing Address - Fax:
Practice Address - Street 1:226 FLATBUSH AVE
Practice Address - Street 2:STORE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4036
Practice Address - Country:US
Practice Address - Phone:718-622-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004463-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician