Provider Demographics
NPI:1003175878
Name:REEDER, MICHAEL T JR (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:REEDER
Suffix:JR
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 1:332 E ASPEN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2204
Mailing Address - Country:US
Mailing Address - Phone:970-858-2020
Mailing Address - Fax:970-858-6601
Practice Address - Street 1:332 E ASPEN AVE
Practice Address - Street 2:STE 100
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2204
Practice Address - Country:US
Practice Address - Phone:970-858-2020
Practice Address - Fax:970-858-6601
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10559078Medicaid
CO10559078Medicaid