Provider Demographics
NPI:1639276660
Name:REIHELD, PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:REIHELD
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 1:331 KING ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1438
Mailing Address - Country:US
Mailing Address - Phone:843-723-0021
Mailing Address - Fax:843-722-5986
Practice Address - Street 1:331 KING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1438
Practice Address - Country:US
Practice Address - Phone:843-723-0021
Practice Address - Fax:843-722-5986
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00635039OtherRAIL ROAD MEDICARE
SCD08622Medicaid
SCD08622Medicaid
SCT83757Medicare UPIN