Healthcare Provider Details

I. General information

NPI: 1629071105
Provider Name (Legal Business Name): ALICIA REED-THOMAS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W NATIONAL AVE
BRAZIL IN
47834-0188
US

IV. Provider business mailing address

603 W NATIONAL AVE PO BOX 188
BRAZIL IN
47834
US

V. Phone/Fax

Practice location:
  • Phone: 812-443-3937
  • Fax: 812-443-3937
Mailing address:
  • Phone: 812-443-3937
  • Fax: 812-443-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002645B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: