MEDICARE: MICHAEL T REEDER JR. O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2916	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003175878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T REEDER JR. O.D.

Provider Business Mailing Address
First Line	:	332 E ASPEN AVE
Second Line	:	STE 100
City	:	FRUITA
State	:	CO
Zip	:	81521-2204
Country	:	US
Telephone Number	:	970-858-2020
Fax Number	:	970-858-6601

Provider Business Practice Location Address
First Line	:	332 E ASPEN AVE
Second Line	:	STE 100
City	:	FRUITA
State	:	CO
Zip	:	81521-2204
Country	:	US
Telephone Number	:	970-858-2020
Fax Number	:	970-858-6601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	03/03/2016

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