Provider Demographics
NPI:1033115365
Name:REID, ROBERT LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:REID
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 1:5419 FM 1960 RD W
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4305
Mailing Address - Country:US
Mailing Address - Phone:281-894-2020
Mailing Address - Fax:281-537-7617
Practice Address - Street 1:5419 FM 1960 RD W
Practice Address - Street 2:SUITE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4305
Practice Address - Country:US
Practice Address - Phone:281-894-2020
Practice Address - Fax:281-537-7617
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2162TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124532605Medicaid
TX8A7651Medicare ID - Type Unspecified
P00041598Medicare PIN
T15492Medicare UPIN