Provider Demographics
NPI:1497735294
Name:REED, KIRK T (O D)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:T
Last Name:REED
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20715 E OCOTILLO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6118
Mailing Address - Country:US
Mailing Address - Phone:480-987-3400
Mailing Address - Fax:480-987-3406
Practice Address - Street 1:20715 E OCOTILLO RD STE 101
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6118
Practice Address - Country:US
Practice Address - Phone:480-987-3400
Practice Address - Fax:480-987-3406
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1750522876Medicaid
AZ179532Medicaid
AZ179532Medicaid
AZU51335Medicare UPIN