Provider Demographics
NPI:1598728800
Name:REED, STEVEN THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:THOMAS
Last Name:REED
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 1:450 5TH AVE SW
Mailing Address - Street 2:P.O. BOX 962
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3960
Mailing Address - Country:US
Mailing Address - Phone:601-849-5004
Mailing Address - Fax:601-849-2801
Practice Address - Street 1:450 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3960
Practice Address - Country:US
Practice Address - Phone:601-849-5004
Practice Address - Fax:601-849-2801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1107140001OtherPALMETTO
MS117949OtherEYEMED
MS00880069Medicaid
MS2230078OtherUNITED HEALTH CARE
MS00880069Medicaid