Provider Demographics
NPI:1386625044
Name:REEVES, DIANA (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 CHERRY CREEK DRIVE SOUTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1532
Mailing Address - Country:US
Mailing Address - Phone:303-220-0393
Mailing Address - Fax:303-740-5865
Practice Address - Street 1:4500 CHERRY CREEK DRIVE SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1518
Practice Address - Country:US
Practice Address - Phone:303-220-0393
Practice Address - Fax:303-740-5865
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43717207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO0690573OtherRAILROAD MEDICARE
CO15681866Medicaid
C811602Medicare PIN
CO68555Medicare UPIN