MEDICARE: JEFFREY REISCH

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	OPC 1610	FL

General Provider Information

NPI Number	:	1104907484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY REISCH

Provider Business Mailing Address
First Line	:	10866 NW 6TH ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2059 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6132
Country	:	US
Telephone Number	:	954-752-0589
Fax Number	:	954-753-1101

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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Directions to “ JEFFREY REISCH ” Practice Location

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