Provider Demographics
NPI:1629282637
Name:REICHENBECHER, MARTIN PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:PAUL
Last Name:REICHENBECHER
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 1:8192 NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:PA
Mailing Address - Zip Code:15411-2104
Mailing Address - Country:US
Mailing Address - Phone:814-395-3479
Mailing Address - Fax:
Practice Address - Street 1:1262 VOCKE RD
Practice Address - Street 2:STE. 100
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7720
Practice Address - Country:US
Practice Address - Phone:301-729-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0613152W00000X
PA0E004573-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist