Provider Demographics
NPI:1982650867
Name:REEDER, KEVIN MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:REEDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9320 CARMEL MOUNTAIN RD
Mailing Address - Street 2:STE E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2159
Mailing Address - Country:US
Mailing Address - Phone:858-484-1500
Mailing Address - Fax:858-484-8416
Practice Address - Street 1:9320 CARMEL MOUNTAIN RD
Practice Address - Street 2:STE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2159
Practice Address - Country:US
Practice Address - Phone:858-484-1500
Practice Address - Fax:858-484-8416
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9076T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19290AMedicare UPIN
BM468ZMedicare PIN