Healthcare Provider Details

I. General information

NPI: 1437224631
Provider Name (Legal Business Name): ROBERT E. REID O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. ROBERT REID

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 DAVID H MCLEOD BLVD
FLORENCE SC
29501-4043
US

IV. Provider business mailing address

9410 COVE DR
MYRTLE BEACH SC
29572-5002
US

V. Phone/Fax

Practice location:
  • Phone: 843-661-0959
  • Fax: 843-661-0927
Mailing address:
  • Phone: 740-360-3966
  • Fax: 843-661-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4224 T1975
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2080
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: