MEDICARE: DR. KEVIN REHAK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000121	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063417202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN REHAK OD

Provider Business Mailing Address
First Line	:	301 N LEWIS RD
Second Line	:	#165
City	:	ROYERSFORD
State	:	PA
Zip	:	19468-1531
Country	:	US
Telephone Number	:	610-948-7000
Fax Number	:	610-948-7002

Provider Business Practice Location Address
First Line	:	301 N LEWIS RD
Second Line	:	#165
City	:	ROYERSFORD
State	:	PA
Zip	:	19468-1531
Country	:	US
Telephone Number	:	610-948-7000
Fax Number	:	610-948-7002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	01/16/2008

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