MEDICARE: RECKLEY EYE CENTER LLC

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	18002071	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	:	1942755194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECKLEY EYE CENTER LLC

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	:

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	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN PATRICK RECKLEY
Credential	:	O.D.
Telephone Number	:	317-781-9090

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	09/30/2016

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Directions to “RECKLEY EYE CENTER LLC ” Practice Location

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