Provider Demographics
NPI:1184866808
Name:VISIONE 360 PA
Entity Type:Organization
Organization Name:VISIONE 360 PA
Other - Org Name:DENNIS J. REITER,D.O.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-532-3937
Mailing Address - Street 1:400 EXECUTIVE CENTER BLVD.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1002
Mailing Address - Country:US
Mailing Address - Phone:915-532-3937
Mailing Address - Fax:915-532-4991
Practice Address - Street 1:400 EXECUTIVE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1004
Practice Address - Country:US
Practice Address - Phone:915-532-3937
Practice Address - Fax:915-532-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0752207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669475109Medicare UPIN