Provider Demographics
NPI:1700857158
Name:REED, JOANNE FORD (OD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:FORD
Last Name:REED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 TUSCAN WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1851
Mailing Address - Country:US
Mailing Address - Phone:904-547-2691
Mailing Address - Fax:904-547-2695
Practice Address - Street 1:124 TUSCAN WAY
Practice Address - Street 2:STE 104
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1851
Practice Address - Country:US
Practice Address - Phone:904-547-2691
Practice Address - Fax:904-547-2695
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20773OtherBCBS
FL62089500Medicaid
FL20773UMedicare PIN
U40406Medicare UPIN
FL62089500Medicaid