Provider Demographics
NPI:1477505808
Name:REYES, JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:REYES
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 1:26381 S TAMIAMI TRL
Mailing Address - Street 2:STE 112
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7803
Mailing Address - Country:US
Mailing Address - Phone:239-992-2020
Mailing Address - Fax:239-992-2005
Practice Address - Street 1:26381 S TAMIAMI TRL
Practice Address - Street 2:STE 112
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7803
Practice Address - Country:US
Practice Address - Phone:239-992-2020
Practice Address - Fax:239-992-2005
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7084213OtherAETNA
FL620218700Medicaid
FL7023203OtherCIGNA
FL20730OtherBLUE CROSS BLUE SHIELD
FLU63466Medicare UPIN
FL20730OtherBLUE CROSS BLUE SHIELD