Provider Demographics
NPI:1356466767
Name:JOSEPH J REDA, O.D., P.C.
Entity Type:Organization
Organization Name:JOSEPH J REDA, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:REDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:856-786-1616
Mailing Address - Street 1:2401 ROUTE 130 S
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3020
Mailing Address - Country:US
Mailing Address - Phone:856-786-1616
Mailing Address - Fax:856-786-3565
Practice Address - Street 1:2401 ROUTE 130 S
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3020
Practice Address - Country:US
Practice Address - Phone:856-786-1616
Practice Address - Fax:856-786-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00286100152W00000X
NJ27OA00470000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
099779Medicare PIN