Provider Demographics
NPI:1053477679
Name:REEVES, JAMES W (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:REEVES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11 5TH ST N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3268
Mailing Address - Country:US
Mailing Address - Phone:406-761-6841
Mailing Address - Fax:406-454-0609
Practice Address - Street 1:11 5TH ST N
Practice Address - Street 2:SUITE 101
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3268
Practice Address - Country:US
Practice Address - Phone:406-761-6841
Practice Address - Fax:406-454-0609
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000026190OtherBCBS
MT0480610Medicaid
MT816045646OtherTRICARE PROVIDER ID
MT0380440001Medicare ID - Type UnspecifiedDURABLE MEDICARE EQUIPMEN
MTT89244Medicare UPIN
MT0480610Medicaid
MT000026190OtherBCBS