Provider Demographics
NPI:1356331839
Name:REISLER, ERIC R (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:REISLER
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 1:702 W DRAKE RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5563
Mailing Address - Country:US
Mailing Address - Phone:970-221-4811
Mailing Address - Fax:970-221-4815
Practice Address - Street 1:702 W DRAKE RD BLDG B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5563
Practice Address - Country:US
Practice Address - Phone:970-221-4811
Practice Address - Fax:970-221-4815
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO540330001OtherDMERC
CO89282329Medicaid
COC458968Medicare PIN
CO89282329Medicaid