Provider Demographics
NPI:1093976755
Name:DR. DARRELL R. REED, OPTOMETRIST INC.
Entity Type:Organization
Organization Name:DR. DARRELL R. REED, OPTOMETRIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:REED
Authorized Official - Suffix:I
Authorized Official - Credentials:OD
Authorized Official - Phone:219-474-6334
Mailing Address - Street 1:105 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:KENTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47951-1211
Mailing Address - Country:US
Mailing Address - Phone:219-474-6334
Mailing Address - Fax:
Practice Address - Street 1:105 N 3RD ST
Practice Address - Street 2:
Practice Address - City:KENTLAND
Practice Address - State:IN
Practice Address - Zip Code:47951-1211
Practice Address - Country:US
Practice Address - Phone:219-474-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier