Provider Demographics
NPI:1629071105
Name:REED-THOMAS, ALICIA (OD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:REED-THOMAS
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 1:603 W NATIONAL AVE
Mailing Address - Street 2:PO BOX 188
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834
Mailing Address - Country:US
Mailing Address - Phone:812-443-3937
Mailing Address - Fax:812-443-3937
Practice Address - Street 1:603 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-0188
Practice Address - Country:US
Practice Address - Phone:812-443-3937
Practice Address - Fax:812-443-3937
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002645B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0730490001OtherDMERC
IN000000080046OtherBLUE CROSS BLUE SHIELD
IN1022881OtherCHAMPUS
IN1490559OtherUMWA
IN100406960AMedicaid
IN410048542OtherRR MEDICARE
INU47303Medicare UPIN
IN410048542OtherRR MEDICARE
IN1490559OtherUMWA