=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215263991
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLLIN WAYNE REINERS O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2009
-----------------------------------------------------
Last Update Date | 01/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 HOLYOKE ST
-----------------------------------------------------
City | HOLYOKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01040-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-532-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 154
-----------------------------------------------------
City | HOUSATONIC
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01236-0154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-717-7601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4775
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------