Provider Demographics
NPI:1043484116
Name:JOHN REIDY O.D.,P.S.
Entity type:Organization
Organization Name:JOHN REIDY O.D.,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REIDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-842-0001
Mailing Address - Street 1:5601 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0826
Mailing Address - Country:US
Mailing Address - Phone:509-842-0001
Mailing Address - Fax:
Practice Address - Street 1:5601 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0826
Practice Address - Country:US
Practice Address - Phone:509-842-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8805615OtherMEDICARE GROUP PIN
WA8805617Medicare PIN
WA8805615OtherMEDICARE GROUP PIN