=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235114935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID RICHARD RAJCHEL OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2005
-----------------------------------------------------
Last Update Date | 02/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 W MARKET ST SUITE 1
-----------------------------------------------------
City | POTTSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17901-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-622-8505
-----------------------------------------------------
Fax | 570-622-9501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 W MARKET ST SUITE 1
-----------------------------------------------------
City | POTTSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17901-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-622-8505
-----------------------------------------------------
Fax | 570-622-9501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | OEG000856
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG 000856
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------