Provider Demographics
NPI:1083835813
Name:DAVID W REAGAN
Entity Type:Organization
Organization Name:DAVID W REAGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDERFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-938-7909
Mailing Address - Street 1:101 YMCA DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5124
Mailing Address - Country:US
Mailing Address - Phone:972-938-7909
Mailing Address - Fax:972-938-2966
Practice Address - Street 1:101 YMCA DR
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5124
Practice Address - Country:US
Practice Address - Phone:972-938-7909
Practice Address - Fax:972-938-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1191207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131197908Medicaid
TX180183902Medicaid
TX131197907Medicaid
TX180183901Medicaid
TX8735B8Medicare PIN
TX180183901Medicaid
TX131197908Medicaid
TX131197907Medicaid
TX0607590002Medicare NSC
TX00925TMedicare PIN
TX8G2630Medicare PIN
TX00936TMedicare PIN
TXB25819Medicare UPIN
TX0607590004Medicare NSC