Provider Demographics
NPI:1679749055
Name:THOMAS P REIS OD PS INC
Entity Type:Organization
Organization Name:THOMAS P REIS OD PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-417-2020
Mailing Address - Street 1:811 GEORGIANA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3511
Mailing Address - Country:US
Mailing Address - Phone:360-417-2020
Mailing Address - Fax:360-417-0254
Practice Address - Street 1:811 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3511
Practice Address - Country:US
Practice Address - Phone:360-417-2020
Practice Address - Fax:360-417-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA990008229OtherRAILROAD
WA2018836Medicaid
108106OtherLABOR AND INDUSTRIES
WA2018836Medicaid
WA6056070001Medicare NSC