Provider Demographics
NPI:1891935888
Name:DWIGHT C SHRECK OD
Entity Type:Organization
Organization Name:DWIGHT C SHRECK OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHRECK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-772-3232
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-0829
Mailing Address - Country:US
Mailing Address - Phone:580-772-3232
Mailing Address - Fax:580-774-2020
Practice Address - Street 1:500 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5700
Practice Address - Country:US
Practice Address - Phone:580-777-2323
Practice Address - Fax:580-774-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1033O152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0272620001Medicare NSC