Provider Demographics
NPI:1083867758
Name:JOANNE F. REED, OD PA PLLC
Entity Type:Organization
Organization Name:JOANNE F. REED, OD PA PLLC
Other - Org Name:JOANNE F. REED, OD,PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-547-2691
Mailing Address - Street 1:124 TUSCAN WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1851
Mailing Address - Country:US
Mailing Address - Phone:904-547-2691
Mailing Address - Fax:904-547-2695
Practice Address - Street 1:124 TUSCAN WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1851
Practice Address - Country:US
Practice Address - Phone:904-547-2691
Practice Address - Fax:904-547-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDT3372Medicare PIN
FLU40406Medicare UPIN
FLFZ440AMedicare PIN