Provider Demographics
NPI:1851476634
Name:REICHERT REICHERT OPTOMETRISTS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:REICHERT REICHERT OPTOMETRISTS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER OF CORPORATION SECRETARY TR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-262-2354
Mailing Address - Street 1:1512 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4913
Mailing Address - Country:US
Mailing Address - Phone:405-262-2354
Mailing Address - Fax:405-262-2451
Practice Address - Street 1:1512 W ELM ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4913
Practice Address - Country:US
Practice Address - Phone:405-262-2354
Practice Address - Fax:405-262-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP8469OtherRAILROAD MEDICARE
CP8469OtherRAILROAD MEDICARE
OK=========OtherVSP
CP8469OtherRAILROAD MEDICARE