MEDICARE: DR. LISA T. REYES 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	OPT-001027	AZ

General Provider Information

NPI Number	:	1831259548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA T. REYES O.D.

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	18555 N 79TH AVE STE A102
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8371
Country	:	US
Telephone Number	:	623-412-2020
Fax Number	:	623-825-7369

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/23/2026

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