Provider Demographics
NPI:1285704031
Name:REED, DAVID J (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:REED
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 1:506 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2817
Mailing Address - Country:US
Mailing Address - Phone:615-384-8435
Mailing Address - Fax:615-384-0859
Practice Address - Street 1:506 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2817
Practice Address - Country:US
Practice Address - Phone:615-384-8435
Practice Address - Fax:615-384-0859
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN359200Medicaid
359200Medicare ID - Type Unspecified
TN359200Medicaid