Provider Demographics
NPI:1033647631
Name:RECKNAGEL, ADAM QUINN (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:QUINN
Last Name:RECKNAGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 NW 79TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4209
Mailing Address - Country:US
Mailing Address - Phone:304-389-8355
Mailing Address - Fax:
Practice Address - Street 1:8605 NW PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1846
Practice Address - Country:US
Practice Address - Phone:816-741-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017015457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist