Reck, Penporn Vongsvivut

Reck, Penporn Vongsvivut is an individual health care provider with primary practice located at 345 College St Se Ste C , Lacey WA 98503-1014. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Retina Specialist, Allopathic & Osteopathic Physicians / Ophthalmology. Allopathic & Osteopathic Physicians / Ophthalmology is 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 Ste C Lacey WA 98503-1014
Fax: (360) 456-3894
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X MD00049407 Washington
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 Apr 10th, 2025 - about last year

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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