Provider Demographics
NPI:1255318747
Name:REISER, DANIEL E (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:REISER
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 1:66 MDS (AFMC)
Mailing Address - Street 2:90 VANDENBERG DRIVE, BLDG 1900
Mailing Address - City:HANSCOM AFB
Mailing Address - State:MA
Mailing Address - Zip Code:01731-2104
Mailing Address - Country:US
Mailing Address - Phone:781-225-6789
Mailing Address - Fax:781-225-2576
Practice Address - Street 1:66 MDS (AFMC)
Practice Address - Street 2:90 VANDENBERG DRIVE, BLDG 1900
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731-2104
Practice Address - Country:US
Practice Address - Phone:781-225-6789
Practice Address - Fax:781-225-2576
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06180000907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD-000Medicare UPIN