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General NPI Number Information
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NPI Number | 1437604006
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Entity Type | Individual
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Provider Name | KATHRYN RECKER O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 10/31/2021
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Provider Practice Location Address
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Address Line | 655 SATURN BLVD STE H
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City | SAN DIEGO
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State | CA
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Zip | 92154-4734
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Country | US
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Telephone | 657-216-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 301 FLEMING AVE
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City | PLACENTIA
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State | CA
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Zip | 92870-1806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33574
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License Number State | CA
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