Provider Demographics
NPI:1164137246
Name:REICHERT, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:REICHERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 SE GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-9293
Mailing Address - Country:US
Mailing Address - Phone:765-584-1320
Mailing Address - Fax:765-584-2317
Practice Address - Street 1:882 SE GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9293
Practice Address - Country:US
Practice Address - Phone:765-584-1320
Practice Address - Fax:765-584-2317
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004468A152W00000X
OHOPT.007131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist