Provider Demographics
NPI:1508941394
Name:REICHERT, PAMELA K (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:K
Last Name:REICHERT
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 1:1512 WEST ELM STREET
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4900
Mailing Address - Country:US
Mailing Address - Phone:405-262-2354
Mailing Address - Fax:405-262-2451
Practice Address - Street 1:1512 WEST ELM STREET
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4900
Practice Address - Country:US
Practice Address - Phone:405-262-2354
Practice Address - Fax:405-262-2451
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK987152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731219351OtherVSP
OK410015826OtherRAILROAD MEDICARE
OK410015826OtherRAILROAD MEDICARE
T40617Medicare UPIN
OK0272300001Medicare NSC