Provider Demographics
NPI:1700895430
Name:THOMAS K. REID, M.D., PROF. CORP.
Entity Type:Organization
Organization Name:THOMAS K. REID, M.D., PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-873-8686
Mailing Address - Street 1:157 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2557
Mailing Address - Country:US
Mailing Address - Phone:760-873-8686
Mailing Address - Fax:873-873-5507
Practice Address - Street 1:157 PIONEER LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2557
Practice Address - Country:US
Practice Address - Phone:760-873-8686
Practice Address - Fax:873-873-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54353207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A543530Medicaid
CAG06576Medicare UPIN
CA00A543530Medicaid