Reck, Penporn Vongsvivut

Reck, Penporn Vongsvivut is an individual health care provider with primary practice located at 345 College St Se Suite C, Lacey WA 98503-1014. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Reck, Penporn Vongsvivut can be contacted via phone (360) 456-3200.

Contact Information

Primary practice address
345 College St Se Suite C Lacey WA 98503-1014
Phone: (360) 456-3200
Fax: (360) 456-3894
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X MD00049407 Washington

Profile Details

NPI number 1811919871
LBN Legal business name Reck, Penporn Vongsvivut
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 25th, 2006
Last updated Nov 17th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811919871 NPPES
Washington MEDICAID 8511552

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