Provider Demographics
NPI:1548327075
Name:REESE, TIMOTHY SCOTT (OD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:REESE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 ROUTE 20 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-8963
Mailing Address - Country:US
Mailing Address - Phone:304-472-2433
Mailing Address - Fax:304-472-2453
Practice Address - Street 1:326 ROUTE 20 SOUTH RD
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-8963
Practice Address - Country:US
Practice Address - Phone:304-472-2433
Practice Address - Fax:304-472-2453
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV756D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150777000Medicaid
WV0150777000Medicaid
WVRE9199201Medicare ID - Type Unspecified