MEDICARE: DR. KEVIN PATRICK RECKLEY KEVIN RECKLEY O.D.

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	18002071B	IN

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	:	1295705218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PATRICK RECKLEY KEVIN RECKLEY O.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	02/09/2011

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