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General NPI Number Information
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NPI Number | 1457370090
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Entity Type | Individual
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Provider Name | JOSEPH RECK O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 EAST END BLVD VA MEDICAL CENTER
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City | WILKES-BARRE
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State | PA
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Zip | 18711
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Country | US
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Telephone | 570-824-3521
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Fax |
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Provider Business Mailing Address
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Address Line | 1434 ROBERT ST
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City | WHITEHALL
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State | PA
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Zip | 18052-4310
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Country | US
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Telephone | 484-347-6951
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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 | OEG001832
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License Number State | PA
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