MEDICARE: JOANNA REED

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	8668T	TX
2	152W00000X	Optometrist	3006	OK

General Provider Information

NPI Number	:	1285017293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA REED

Provider Business Mailing Address
First Line	:	PO BOX 547
Second Line	:
City	:	MINEOLA
State	:	TX
Zip	:	75773-0547
Country	:	US
Telephone Number	:	903-569-5432
Fax Number	:	903-569-2994

Provider Business Practice Location Address
First Line	:	1201 KIOWA ST STE A
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2246
Country	:	US
Telephone Number	:	580-223-8585
Fax Number	:	580-223-8588

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

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	01/30/2020

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Directions to “ JOANNA REED ” Practice Location

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