MEDICARE: KEVIN P RECKLEY 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	332H00000X	Eyewear Supplier	18002071	IN

General Provider Information

NPI Number	:	1184898926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN P RECKLEY OD

Provider Business Mailing Address
First Line	:	5611 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3750
Country	:	US
Telephone Number	:	317-781-9090
Fax Number	:	317-782-3937

Provider Business Practice Location Address
First Line	:	5611 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3750
Country	:	US
Telephone Number	:	317-781-9090
Fax Number	:	317-782-3937

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN P RECKLEY
Credential	:	OD
Telephone Number	:	317-781-9090

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/14/2008

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