Provider Demographics
NPI:1346232253
Name:REESE, TIMOTHY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:REESE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 VILLAGE RIDGE PT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8992
Mailing Address - Country:US
Mailing Address - Phone:719-488-9595
Mailing Address - Fax:719-488-8383
Practice Address - Street 1:1180 VILLAGE RIDGE PT
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8992
Practice Address - Country:US
Practice Address - Phone:719-488-9595
Practice Address - Fax:719-488-8383
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-11-18
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CO1625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08016255Medicaid
COCF3063Medicare PIN
COK9228Medicare UPIN