MEDICARE: TINA REEVES OD

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	332H00000X	Eyewear Supplier	UVT005332	NY
2	152W00000X	Optometrist	UVT005332	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P010005332	OTHER	NY	BCBS OF ROCHESTER AREA
2	5773707	OTHER	NY	AETNA
3	101998CS	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1902886948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA REEVES OD

Provider Business Mailing Address
First Line	:	17 STATE ST
Second Line	:	POWERS BUILDING ATRIUM
City	:	ROCHESTER
State	:	NY
Zip	:	14614-1302
Country	:	US
Telephone Number	:	585-797-0601
Fax Number	:	585-797-0603

Provider Business Practice Location Address
First Line	:	17 STATE ST
Second Line	:	POWERS BUILDING ATRIUM
City	:	ROCHESTER
State	:	NY
Zip	:	14614-1302
Country	:	US
Telephone Number	:	585-797-0601
Fax Number	:	585-340-7950

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	04/17/2020

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