Provider Demographics
NPI:1912017963
Name:REEDY, DANIEL JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:REEDY
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 1:2217 MAIN ST
Mailing Address - Street 2:BOX 329
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-2446
Mailing Address - Country:US
Mailing Address - Phone:712-852-2979
Mailing Address - Fax:712-852-2024
Practice Address - Street 1:2217 MAIN ST
Practice Address - Street 2:BOX 329
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-2446
Practice Address - Country:US
Practice Address - Phone:712-852-2979
Practice Address - Fax:712-852-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01629152W00000X, 152WC0802X, 152WL0500X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12959OtherBLUE CROSS
IA0129593Medicaid
IA0129593Medicaid
IAT00810Medicare UPIN
IA25386Medicare PIN
IA12959Medicare PIN
IA12959OtherBLUE CROSS