Provider Demographics
NPI:1598984627
Name:REED, JOHN C (LDO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:REED
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:957 BAXTER ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3754
Mailing Address - Country:US
Mailing Address - Phone:706-549-4457
Mailing Address - Fax:706-353-3168
Practice Address - Street 1:957 BAXTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3754
Practice Address - Country:US
Practice Address - Phone:706-549-4457
Practice Address - Fax:706-353-3168
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01741156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0130170001Medicare NSC