Provider Demographics
NPI:1619146131
Name:DR. REISING AND BURKHART
Entity Type:Organization
Organization Name:DR. REISING AND BURKHART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-962-2243
Mailing Address - Street 1:1900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5708
Mailing Address - Country:US
Mailing Address - Phone:765-962-2243
Mailing Address - Fax:765-966-6199
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5708
Practice Address - Country:US
Practice Address - Phone:765-962-2243
Practice Address - Fax:765-966-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100256230Medicaid
IN0180800001Medicare NSC
INCG0772Medicare PIN