Provider Demographics
NPI:1578631677
Name:REESE, BRUCE L (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:REESE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1904 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5900
Practice Address - Country:US
Practice Address - Phone:252-492-9559
Practice Address - Fax:252-439-5581
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909756Medicaid
246492GMedicare ID - Type Unspecified
T65022Medicare UPIN