Provider Demographics
NPI:1295760643
Name:REIS, AMY LYNN (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:REIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:SPANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:201 M ST
Mailing Address - Street 2:
Mailing Address - City:LOUP CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68853-8031
Mailing Address - Country:US
Mailing Address - Phone:308-381-4797
Mailing Address - Fax:308-381-5820
Practice Address - Street 1:2250 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-381-4797
Practice Address - Fax:308-381-5820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36358OtherBCBS OF NE
NE10025993600Medicaid
NE34983OtherAVESIS
18578OtherCOAST-TO-COAST
48306OtherDAVIS VA
1985901OtherBLOCK VISION
551326OtherNVA
04199OtherSPECTRA
NE10025050600Medicaid
NE10025050600Medicaid