Provider Demographics
NPI:1891770434
Name:RECKER, MICHAEL LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:RECKER
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 1:410 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2269
Mailing Address - Country:US
Mailing Address - Phone:419-872-2020
Mailing Address - Fax:419-872-2029
Practice Address - Street 1:410 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2269
Practice Address - Country:US
Practice Address - Phone:419-872-2020
Practice Address - Fax:419-872-2029
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000360076OtherBLUE CROSS BLUE SHIE PIN
OH2046708Medicaid
OH000000360076OtherBLUE CROSS BLUE SHIE PIN
OHU78424Medicare UPIN
OH0896212Medicare ID - Type UnspecifiedPROVIDER #