Provider Demographics
NPI:1558404194
Name:REINHOLDT, RENEE SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:SUE
Last Name:REINHOLDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 N MESQUITE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5442
Mailing Address - Country:US
Mailing Address - Phone:317-590-5372
Mailing Address - Fax:
Practice Address - Street 1:1495 S BLACK RIDGE DR
Practice Address - Street 2:SUITE A270
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5622
Practice Address - Country:US
Practice Address - Phone:435-628-9100
Practice Address - Fax:877-591-6983
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003272A152W00000X
UT8516710-9934152W00000X
NV900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000077785Medicare PIN
NVV50424Medicare UPIN