Provider Demographics
NPI:1427220854
Name:REESER, SHAWN LEE
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:LEE
Last Name:REESER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-3428
Mailing Address - Country:US
Mailing Address - Phone:580-399-4426
Mailing Address - Fax:
Practice Address - Street 1:304 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-3428
Practice Address - Country:US
Practice Address - Phone:580-399-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician