Provider Demographics
NPI:1821563396
Name:REESE EYE CARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:REESE EYE CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-488-9595
Mailing Address - Street 1:1180 VILLAGE RIDGE PT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8992
Mailing Address - Country:US
Mailing Address - Phone:719-488-9595
Mailing Address - Fax:719-488-8383
Practice Address - Street 1:1180 VILLAGE RIDGE PT
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8992
Practice Address - Country:US
Practice Address - Phone:719-488-9595
Practice Address - Fax:719-488-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080016255Medicaid