Provider Demographics
NPI:1417066648
Name:REECE, DUSTIN LEE (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEE
Last Name:REECE
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 FAITH RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-7005
Mailing Address - Country:US
Mailing Address - Phone:704-637-7728
Mailing Address - Fax:
Practice Address - Street 1:223 FAITH RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-7005
Practice Address - Country:US
Practice Address - Phone:704-637-7728
Practice Address - Fax:704-636-4284
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136FJMedicaid
NC89136FJMedicaid
NC2473204AMedicare PIN