Provider Demographics
NPI:1437224631
Name:REID, ROBERT E (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:REID
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9410 COVE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5002
Mailing Address - Country:US
Mailing Address - Phone:740-360-3966
Mailing Address - Fax:843-661-0927
Practice Address - Street 1:2701 DAVID H MCLEOD BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4043
Practice Address - Country:US
Practice Address - Phone:843-661-0959
Practice Address - Fax:843-661-0927
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4224 T1975152WC0802X
SC2080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000195053OtherANTHEM BLUE CROSS BLUE SHIELD
OH000000195053OtherANTHEM BLUE CROSS BLUE SHIELD
OHU12819Medicare UPIN
OH2740056Medicaid
OH0748590001Medicare NSC