Provider Demographics
NPI:1831259548
Name:REYES, LISA T (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:T
Last Name:REYES
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3635 E INVERNESS AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3848
Mailing Address - Country:US
Mailing Address - Phone:480-890-0618
Mailing Address - Fax:480-462-0121
Practice Address - Street 1:7650 W BELL RD # 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-412-2020
Practice Address - Fax:623-825-7369
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-02-24
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Provider Licenses
StateLicense IDTaxonomies
AZ1027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist