Provider Demographics
NPI:1013991454
Name:REED, LAWRENCE D (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:REED
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 1:6708 RAYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-5272
Mailing Address - Country:US
Mailing Address - Phone:816-353-1872
Mailing Address - Fax:816-353-5022
Practice Address - Street 1:6708 RAYTOWN RD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5272
Practice Address - Country:US
Practice Address - Phone:816-353-1872
Practice Address - Fax:816-353-5022
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02419152W00000X
KS1174-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT02419OtherLICENSE
0185130001OtherDMERC
MO311382527Medicaid
410008504OtherRAILROAD MEDICARE
KS1174-3OtherLICENSE
T42522Medicare UPIN
MOT02419OtherLICENSE