Healthcare Provider Details

I. General information

NPI: 1063417202
Provider Name (Legal Business Name): KEVIN REHAK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N LEWIS RD #165
ROYERSFORD PA
19468-1531
US

IV. Provider business mailing address

301 N LEWIS RD #165
ROYERSFORD PA
19468-1531
US

V. Phone/Fax

Practice location:
  • Phone: 610-948-7000
  • Fax: 610-948-7002
Mailing address:
  • Phone: 610-948-7000
  • Fax: 610-948-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000121
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: