Provider Demographics
NPI:1932158151
Name:REISING, GREGORY G (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:REISING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5708
Mailing Address - Country:US
Mailing Address - Phone:765-962-2243
Mailing Address - Fax:765-966-6199
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5708
Practice Address - Country:US
Practice Address - Phone:765-962-2243
Practice Address - Fax:765-966-6199
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001676A152W00000X
IN18001676B152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN437880Medicare PIN
INT34809Medicare UPIN