MEDICARE: DR. ADAM G REISING O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18003241B	IN
2	152W00000X	Optometrist	18003241A	IN
3	152WC0802X	Corneal and Contact Management Optometrist	18003241B	IN
4	152WP0200X	Pediatric Optometrist	18003241B	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00077714	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0180800001	OTHER	IN	DMERC

General Provider Information

NPI Number	:	1386692648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM G REISING O.D.

Provider Business Mailing Address
First Line	:	1900 E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-5708
Country	:	US
Telephone Number	:	765-962-2243
Fax Number	:	765-966-6199

Provider Business Practice Location Address
First Line	:	1900 E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-5708
Country	:	US
Telephone Number	:	765-962-2243
Fax Number	:	765-966-6199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/26/2008

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Directions to “ DR. ADAM G REISING O.D.” Practice Location

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