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General NPI Number Information
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NPI Number | 1851396873
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Entity Type | Individual
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Provider Name | DWIGHT CHARLES SHRECK O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 N WASHINGTON AVE. BOX 829
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City | WEATHERFORD
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State | OK
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Zip | 73096-0829
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Country | US
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Telephone | 580-772-3232
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Fax | 580-774-2020
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Provider Business Mailing Address
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Address Line | 500 N WASHINGTON AVE. BOX 829
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City | WEATHERFORD
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State | OK
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Zip | 73096
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Country | US
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Telephone | 580-772-3232
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Fax | 580-774-2020
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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 | 1033
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License Number State | OK
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