Provider Demographics
NPI:1932246626
Name:REED, ROBERT E JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:REED
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2047 NILES ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2505
Mailing Address - Country:US
Mailing Address - Phone:269-983-3200
Mailing Address - Fax:269-983-4902
Practice Address - Street 1:2047 NILES ROAD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2505
Practice Address - Country:US
Practice Address - Phone:269-983-3200
Practice Address - Fax:269-983-4902
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP62220001Medicare PIN
T32643Medicare UPIN
ON37230001Medicare ID - Type Unspecified