Provider Demographics
NPI:1902835069
Name:REICHERT EYE CENTERS OF N FL, PA
Entity Type:Organization
Organization Name:REICHERT EYE CENTERS OF N FL, PA
Other - Org Name:DBA FAMILY FOCUS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-755-2785
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-0489
Mailing Address - Country:US
Mailing Address - Phone:386-755-2785
Mailing Address - Fax:386-755-1128
Practice Address - Street 1:1615 SW MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1108
Practice Address - Country:US
Practice Address - Phone:386-755-2785
Practice Address - Fax:386-755-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055182207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250697100Medicaid
FL40642Medicare PIN
FL250697100Medicaid