Provider Demographics
NPI:1104896455
Name:REED, KEVEN CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:KEVEN
Middle Name:CHARLES
Last Name:REED
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1651 COUNTRY WALK DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8614
Mailing Address - Country:US
Mailing Address - Phone:904-505-7277
Mailing Address - Fax:904-264-3685
Practice Address - Street 1:905 PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4110
Practice Address - Country:US
Practice Address - Phone:904-264-1206
Practice Address - Fax:904-264-3685
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621349900Medicaid
FLP00758581Medicare PIN
FLAM242ZMedicare PIN