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NPI Code Detail

MEDICARE: DR. JOHN F REIDY O.D., P.S.

MEDICARE: DR. JOHN F REIDY O.D., P.S.
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
1152W00000XOptometrist1612WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18805615OTHERWAMEDICARE GROUP PIN

General Provider Information

NPI Number : 1417041070
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN F REIDY O.D., P.S.
Provider Business Mailing Address
First Line : 5601 E SPRAGUE AVE
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99212-0826
Country : US
Telephone Number : 509-842-0001
Fax Number : 509-842-0013
Provider Business Practice Location Address
First Line : 5601 E SPRAGUE AVE
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99212-0826
Country : US
Telephone Number : 509-842-0001
Fax Number : 509-842-0013
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 04/18/2008

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