Provider Demographics
NPI:1124081641
Name:DEE-REYES, CHRISTINE (OD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DEE-REYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26381 S TAMIAMI TRL STE 112
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7803
Mailing Address - Country:US
Mailing Address - Phone:239-992-2020
Mailing Address - Fax:239-992-2005
Practice Address - Street 1:15620 MCGREGOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33908-2528
Practice Address - Country:US
Practice Address - Phone:239-992-2020
Practice Address - Fax:239-992-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2994152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20728XOtherMEDICARE ID UNSPECIFIED
FL620221700Medicaid
FL7973589OtherAETNA
FL20728OtherBLUE CROSS BLUE SHIELD
FL6689374OtherCIGNA
FL20728Medicare ID - Type Unspecified
FLU63464Medicare UPIN