MEDICARE: DR. KEVIN MATTHEW REEDER 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	9076T	CA

General Provider Information

NPI Number	:	1982650867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MATTHEW REEDER O.D.

Provider Business Mailing Address
First Line	:	9320 CARMEL MOUNTAIN RD
Second Line	:	STE E
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2159
Country	:	US
Telephone Number	:	858-484-1500
Fax Number	:	858-484-8416

Provider Business Practice Location Address
First Line	:	9320 CARMEL MOUNTAIN RD
Second Line	:	STE E
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2159
Country	:	US
Telephone Number	:	858-484-1500
Fax Number	:	858-484-8416

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/07/2009

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