Provider Demographics
NPI:1821140260
Name:REEVES, DOUG V (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUG
Middle Name:V
Last Name:REEVES
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 1:1102 MARTHA BERRY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1612
Mailing Address - Country:US
Mailing Address - Phone:706-291-4642
Mailing Address - Fax:706-291-9644
Practice Address - Street 1:1102 MARTHA BERRY BLVD NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1612
Practice Address - Country:US
Practice Address - Phone:706-291-4642
Practice Address - Fax:706-291-9644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA963152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4000004386AMedicaid
GA41ZCCFFMedicare ID - Type UnspecifiedMEDICARE PROVIDER#2
GAU22544Medicare UPIN
GA4000004386AMedicaid