Provider Demographics
NPI:1528134103
Name:REARDON, LOUIS WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:WILLIAM
Last Name:REARDON
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 1:7 DEL MONTE PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2103
Mailing Address - Country:US
Mailing Address - Phone:302-762-1500
Mailing Address - Fax:302-762-4451
Practice Address - Street 1:7 DEL MONTE PL
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2103
Practice Address - Country:US
Practice Address - Phone:302-762-1500
Practice Address - Fax:302-762-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI20001127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DET26929Medicare UPIN
DE120644Medicare ID - Type UnspecifiedOPTOMETRIST