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General NPI Number Information
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NPI Number | 1932476983
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Entity Type | Organization
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Legal Business Name | JOHN W REED OD LLC
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Dates
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Enumeration Date | 11/18/2011
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 1356 S GILBERT RD STE 3
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City | MESA
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State | AZ
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Zip | 85204-6077
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Country | US
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Telephone | 480-545-9120
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Fax | 480-545-9384
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Provider Business Mailing Address
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Address Line | 1356 S GILBERT RD STE 3
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City | MESA
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State | AZ
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Zip | 85204-6077
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Country | US
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Telephone | 480-545-9120
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Fax | 480-545-9384
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JOHN W REED
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Credential | O.D.
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Telephone | 480-545-9120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 189
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License Number State | AZ
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