Provider Demographics
NPI:1871530907
Name:REID, THOMAS KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:157 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2557
Mailing Address - Country:US
Mailing Address - Phone:760-873-8686
Mailing Address - Fax:760-873-5507
Practice Address - Street 1:157 PIONEER LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2557
Practice Address - Country:US
Practice Address - Phone:760-873-8686
Practice Address - Fax:760-873-5507
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54353207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A543530Medicaid
CA00A543530Medicaid
CA00A543531Medicare PIN