Provider Demographics
NPI:1396792982
Name:REED, PAUL EDWARD (OD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:REED
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2480 S HIGHWAY 89
Mailing Address - Street 2:SUITE B
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-6727
Mailing Address - Country:US
Mailing Address - Phone:435-239-7518
Mailing Address - Fax:435-239-8735
Practice Address - Street 1:2480 S HIGHWAY 89
Practice Address - Street 2:SUITE B
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-6727
Practice Address - Country:US
Practice Address - Phone:435-239-7518
Practice Address - Fax:435-239-8735
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369424-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTMR0707349OtherD.E.A.
UTMR0707349OtherD.E.A.
005777501Medicare PIN