Provider Demographics
NPI:1134340946
Name:ANNE C. REAM, OPTOMETRY, PC
Entity type:Organization
Organization Name:ANNE C. REAM, OPTOMETRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:REAM
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:417-967-4090
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-0553
Mailing Address - Country:US
Mailing Address - Phone:417-967-4090
Mailing Address - Fax:417-967-4091
Practice Address - Street 1:112 W PINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-1241
Practice Address - Country:US
Practice Address - Phone:417-967-4090
Practice Address - Fax:417-967-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO313562522Medicaid
MO313562522Medicaid
MOT42798Medicare UPIN