Provider Demographics
NPI:1306091574
Name:MICHAEL L. RECKER, O.D. LLC
Entity type:Organization
Organization Name:MICHAEL L. RECKER, O.D. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:M
Authorized Official - Last Name:RECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-872-2020
Mailing Address - Street 1:410 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2269
Mailing Address - Country:US
Mailing Address - Phone:419-872-2020
Mailing Address - Fax:419-872-2029
Practice Address - Street 1:410 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2269
Practice Address - Country:US
Practice Address - Phone:419-872-2020
Practice Address - Fax:419-872-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4870332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891770434OtherINDIVIDUAL NPI
OH2046708Medicaid
1891770434OtherINDIVIDUAL NPI
OH0896212Medicare PIN