Provider Demographics
NPI:1346297058
Name:REAVES, LISA H (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:REAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-395-8805
Mailing Address - Fax:740-395-8834
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5139
Practice Address - Fax:740-446-8683
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-3872207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2467772OtherMOLINA MEDICAID #
OH310917085108OtherCARESOURCE MEDICAID #
001714155OtherMOUNTAIN STATE BCBS
OHP00116589OtherRR MEDICARE
OH000000181651OtherUNISON MEDICAID #
000000331620OtherANTHEM BCBS
WV3000166000Medicaid
OH2467772Medicaid
OHP00116589OtherRR MEDICARE
OH2467772Medicaid