Healthcare Provider Details

I. General information

NPI: 1659626638
Provider Name (Legal Business Name): STEPHEN M REINSEL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 STATE ROUTE 257
SENECA PA
16346-2529
US

IV. Provider business mailing address

3285 STATE ROUTE 257
SENECA PA
16346-2529
US

V. Phone/Fax

Practice location:
  • Phone: 814-677-6636
  • Fax: 814-677-9562
Mailing address:
  • Phone: 814-677-6636
  • Fax: 814-677-9562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOEG002685
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOEG002685
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOEG002685
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: