Healthcare Provider Details

I. General information

NPI: 1720131410
Provider Name (Legal Business Name): BRIAN C REEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 4TH AVE NE
SEATTLE WA
98115-2143
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 206-527-7299
  • Fax:
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00003301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: