=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891935888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DWIGHT C SHRECK OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2009
-----------------------------------------------------
Last Update Date | 03/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N WASHINGTON ST
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73096-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-777-2323
-----------------------------------------------------
Fax | 580-774-2020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 829
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73096-0829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-772-3232
-----------------------------------------------------
Fax | 580-774-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DWIGHT C SHRECK
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 580-772-3232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1033O
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------