Provider Demographics
NPI:1407840309
Name:REID, FLINT C (OD)
Entity Type:Individual
Prefix:
First Name:FLINT
Middle Name:C
Last Name:REID
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:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-0520
Mailing Address - Country:US
Mailing Address - Phone:207-487-3937
Mailing Address - Fax:
Practice Address - Street 1:453 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967
Practice Address - Country:US
Practice Address - Phone:207-487-3937
Practice Address - Fax:207-487-3936
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME207660001Medicaid
ME207660001Medicaid
ME703723Medicare ID - Type Unspecified