MEDICARE: DR. DWIGHT CHARLES SHRECK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1033	OK

General Provider Information

NPI Number	:	1851396873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT CHARLES SHRECK O.D.

Provider Business Mailing Address
First Line	:	500 N WASHINGTON AVE. BOX 829
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096
Country	:	US
Telephone Number	:	580-772-3232
Fax Number	:	580-774-2020

Provider Business Practice Location Address
First Line	:	500 N WASHINGTON AVE. BOX 829
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-0829
Country	:	US
Telephone Number	:	580-772-3232
Fax Number	:	580-774-2020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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