Provider Demographics
NPI:1285862599
Name:IVIE, JARED REESE (OD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:REESE
Last Name:IVIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2405 JAFER CT
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5587
Mailing Address - Country:US
Mailing Address - Phone:208-529-2700
Mailing Address - Fax:208-529-0873
Practice Address - Street 1:2405 JAFER CT
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5587
Practice Address - Country:US
Practice Address - Phone:208-529-2700
Practice Address - Fax:208-529-0873
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist