Provider Demographics
NPI:1902886948
Name:REEVES, TINA (OD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 STATE ST
Mailing Address - Street 2:POWERS BUILDING ATRIUM
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14614-1302
Mailing Address - Country:US
Mailing Address - Phone:585-797-0601
Mailing Address - Fax:585-797-0603
Practice Address - Street 1:17 STATE ST
Practice Address - Street 2:POWERS BUILDING ATRIUM
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1302
Practice Address - Country:US
Practice Address - Phone:585-797-0601
Practice Address - Fax:585-340-7950
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUVT005332332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010005332OtherBCBS OF ROCHESTER AREA
NY5773707OtherAETNA
NY101998CSOtherPREFERRED CARE
NYU40685Medicare UPIN
NY13060BMedicare ID - Type Unspecified