MEDICARE: THOMAS K. REID, M.D., PROF. CORP.

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	207W00000X	Ophthalmology Physician	A54353	CA

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	:	1700895430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS K. REID, M.D., PROF. CORP.

Provider Business Mailing Address
First Line	:	157 PIONEER LN
Second Line	:
City	:	BISHOP
State	:	CA
Zip	:	93514-2557
Country	:	US
Telephone Number	:	760-873-8686
Fax Number	:	873-873-5507

Provider Business Practice Location Address
First Line	:	157 PIONEER LN
Second Line	:
City	:	BISHOP
State	:	CA
Zip	:	93514-2557
Country	:	US
Telephone Number	:	760-873-8686
Fax Number	:	873-873-5507

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. MICHELLE LEIGH REID
Credential	:
Telephone Number	:	760-873-8686

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/28/2014

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